Personalizing HIV Therapeutics in Resource-Limited Rural Communities: Lessons Learned From the Use of New Tools in Africa

Abstract

With growing information on antiretroviral drug pharmacogenetics, several studies have been conducted in African countries. One unique strand of knowledge that is currently emerging is the use of dried plasma spot devices in rural communities in Africa with a view to individualizying drugs employed against HIV infection. The results are encouraging as a relatively inexpensive test could inform on the probability of adverse reactions or treatment failure, thus helping to select the best regimen for a given patient in different African populations. This could have an important impact in African countries where anti-viral therapy failures (whether related to low adherence/intolerance or to resistance/insufficient drugs exposure) have huge associated costs, both in terms of disease progression and money expenditure. Data on the available information on pharmacogenetics in African patients as well as patients of African descendant are reviewed. Nevertheless no randomized controlled study evaluating the impact of pharmacogenetics in Africa has so far been conducted, particularly with a view to employing novel diagnostic platforms such as dried plasma/blood spot devices in rural communities. Following the discussed data a few candidate genes are suggested as potential candidates for prospective studies taking into account two pitfalls in the path towards individualized antiretroviral regimens in Africa: the reliance on non-African based laboratories that signal the need for local capacity building as well as international collaborations, and finally the need to better understand genetic diversity of different ethnic groups in the African continent. Keywords: Antiretrovirals, Africa, HIV, limited resource countries, personalized medicine, pharmacogenetics, single nucleotide polymorphisms, therapeutic drug monitoring.