HIV infection and AIDS: Edited by Martin FisherPharmacogenetics and the potential for the individualization of antiretroviral therapyPhillips, Elizabeth Ja; Mallal, Simon AbAuthor Information aCentre for Clinical Pharmacology & Infectious Diseases, Australia bCentre for Clinical Immunology & Biomedical Statistics, Institute for Immunology & Infectious Diseases, Royal Perth Hospital, Murdoch University, Perth, Australia Correspondence to Elizabeth J. Phillips, MD, FRCPC, Centre for Clinical Pharmacology & Infectious Diseases, Murdoch University, Department of Clinical Immunology & Immunogenetics, 2nd Floor, North Block, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia Tel: +61 892243881; fax: +61 893877478; e-mail: [email protected] Current Opinion in Infectious Diseases: February 2008 - Volume 21 - Issue 1 - p 16-24 doi: 10.1097/QCO.0b013e3282f42224 Buy Metrics Abstract Purpose of review Genetic associations highlighting differences in the response to HIV infection and treatment have significantly furthered our understanding of the pathogenesis, pharmacokinetics and pharmacodynamics of antiretroviral drug action and toxicities and HIV disease itself. This review focuses on the current knowledge of associations between polymorphisms and treatment outcomes in HIV with particular emphasis on clinically relevant relationships likely to lead to the individualization of antiretroviral therapy. Recent findings Our understanding of the immunogenetic basis of drug toxicity has been furthered by human leucocyte antigen associations with hypersensitivities for the antiretroviral drugs abacavir and nevirapine. For abacavir in particular, the use of HLA-B*5701 as a screening test appears to be generalizable across racially diverse populations and has been supported by both observational, and blinded randomized controlled trials. Summary Differences in HIV acquisition and progression as well as antiretroviral efficacy and toxicity will continue to provide the basis for research to define the genetic basis of such diversity. Despite the plethora of research in this area, numerous barriers exist to the successful operationalization of genetic testing to the clinic. HLA-B*5701 screening to prevent abacavir hypersensitivity is currently the most relevant to clinical practice and highlights that the promise of cost-effective testing can be facilitated by robust laboratory methodology and quality assurance programs that can be applied to diverse treatment settings. © 2008 Lippincott Williams & Wilkins, Inc.