It is spread worldwide and the number is increasing among races. According to the Center for Disease Control Black/African Americans account for a higher proportion of new HIV diagnoses, those living with HIV, and those who have ever received an AIDS diagnosis, compared to other races/ ethnicities. The disease can be challenging and contribute to mortality if left untreated. In 2016, African American accounted for 44% of HIV diagnoses though they comprise 12% of the U.S. population. The issues that this particular population faced are vast and may delay their resolution to seek help. Many factors may create barriers for African Americans to get access to care: lack of education, stigma, fear of rejection, socio economical means and limited access to health care. Challenges that they face make them vulnerable to diseases.
The CD4 cells (T-cells) that help the immune system fight off infections are compromised in HIV patients and impede with the bodies abilities to fight them. With fewer CD4 cells, the bodies lose its ability to fight infections. HIV can be transmitted through different routes, needles or syringe injections, sexual contact with multiple partners and blood transfusions etc.
In this perspective, more measures need to be taken to face the challenges, to promote wellbeing and improvement in the African American population. Along with raising awareness, education and lifestyle changes, the use of medications can help improve the health of those infected with the virus. Antiretroviral therapy has played a role in life expectancy of HIV affected patients. These medications are lifelong drugs and work better based on the patient genetic makeup. Pharmacogenomics direct the combined effects of multiple genes on the response to ART and help avoid toxicity related to HIV drug therapy. There is some evidence that African Americans metabolize medications differently.
HIV is treated with different drugs. They prevent the HI virus from making copies of itself, blocking the virus from infecting new cells and keeping them from entering healthy cells. Drug response is influenced by a multitude of genes. Additionally, the use of genetic profile plays a crucial role in the management of the disease and to minimize adverse effects. This will guide the decision to prescribe the right medication to the right patient. This paper will focus on 3 different drugs and their pharmacogenetic effects on the African American population.
Abacavir is a medication used to treat HIV infection. This medication has serious adverse effects , hypersensitivity reactions can occur in approximately 5% of the population who are taking the drug. A variant allele in the HLA-B gene, a critical part of the immune system was shown to strongly correlate with the risk of developing Hypersensitivity reaction ( HSR). It has been showed that pharmacogenetics testing for HLA-B*57:01 resulted in a significantly decreased incidence of abacavir HSR ( Martin & Kroetz, 2013).
Protease inhibitors are one of the HIV medications groups that are very beneficial and are often used to treat the disease. These drugs obstruct the action of protease enzyme and stop HIV lifecycle. They decrease morbidity and mortality due to the disease. Among these medications is ritonavir. Ritonavir is primarily metabolized by CYP3A4 isoenzymes, plus it is a substrate of CYP1A2CYP2B6, and CYP2D6 isoenzymes. In addition to its strong inhibition of CYP2D6, ritonavir also strongly inhibits CYP2C8 and CYP2D6 isoenzymes ( Rosenthal & Burchum, 2018, p.894).
Zidovudine( ZDV)- From a pharmacological point of view, Zidovudine is a nucleotide reverse transcriptase inhibitor widely used and was the first approved antiviral medication for HIV infection. The selective affinity of HIV reverse transcriptase makes Zidovudine effective in treating HIV contrarily to human DNA polymerases. Zidovudine may increase plasma concentrations. A pharmacogenetics study has reported higher levels of ZDV- triphosphates 9 up to 49%) in HIV cases heterozygotes for ABCC4G3724A on ZDV treatment as compared to wild type GG homozygote. Another variant ABCB1 GT or TT has shown significantly reduced level of HIV viral load than that in individuals having wild type GG genotype ( Ghodke Y.,, Klein, T.E. 2012).
Improving awareness about HIV treatment and lifestyle modifications may help increase adherence particularly among African Americans and decrease the rate of people infected with the disease.
Ghodke, Y., Anderson, P.L., Sangkuhl, J.L., Lamba, J.Altman, R. B. & Klein, T. E. ( 2012 ). Pharm GB Summary:ZidovudinePathway.PharmacogenetGenomics.Retrievedfromhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmc3696524/
HIV among African Americans.Centers for Disease Control and Prevention ( 2017). Retrieved from https:// www. cdc.gov/hiv/group/racial ethnic/African americans /index.html
Martin, M.A. & Kroetz, D.L.(2013). Abacavir Pharmacogenetics- From Initial Reports to Standard of Care. Retrieved from https://www.ncbi,nlm.nih.gov/pubmed/23649914
Rosenthal, L.D.& Burchum, J.R. (2018). Lehne’s Pharmacotherapeutics for Advanced Practice Providers. ST Louis: Elsevier