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. 2014 Feb 14;9(2):e88497.
doi: 10.1371/journal.pone.0088497. eCollection 2014.

Therapeutic drug monitoring and pharmacogenetic study of HIV-infected ethnic Chinese receiving efavirenz-containing antiretroviral therapy with or without rifampicin-based anti-tuberculous therapy

Kuan-Yeh Lee  1 , Shu-Wen Lin  2 , Hsin-Yun Sun  3 , Ching-Hua Kuo  4 , Mao-Song Tsai  5 , Bing-Ru Wu  6 , Sue-Yo Tang  7 , Wen-Chun Liu  3 , Sui-Yuan Chang  8 , Chien-Ching Hung  9
Affiliations

Therapeutic drug monitoring and pharmacogenetic study of HIV-infected ethnic Chinese receiving efavirenz-containing antiretroviral therapy with or without rifampicin-based anti-tuberculous therapy

Kuan-Yeh Lee et al. PLoS One. .

Abstract

Objectives: Plasma efavirenz concentrations in HIV-infected patients with tuberculosis (TB) may be affected by cytochrome P450 (CYP) 2B6 single-nucleotide polymorphisms and concurrent rifampicin use. We aimed to investigate the effects of CYP2B6 G516T polymorphisms and concomitant rifampicin use on the plasma efavirenz concentrations in HIV-infected Taiwanese.

Methods: HIV-infected patients with or without TB who had received combination antiretroviral therapy containing efavirenz (600 mg daily) for two weeks or greater were enrolled for determinations of CYP2B6 G516T polymorphism and plasma efavirenz concentrations with the use of polymerase-chain-reaction restriction fragment-length polymorphism and high-performance liquid chromatography, respectively.

Results: From October 2009 to August 2012, 171 HIV-infected patients, including 18 with TB, were enrolled 113 (66.1%) with CYP2B6 G516G, 55 (32.2%) GT, and 3 (1.8%) TT genotype. Patients receiving rifampicin had a significantly lower median plasma efavirenz concentration than the control group (2.16 vs 2.92 mg/L, P = 0.003); however, all patients achieved target plasma concentration (>1 mg/L). Patients with GT or TT genotype had a significantly higher plasma concentration than those with GG genotype (2.50 vs 3.47 mg/L for GT genotype and 8.78 mg/L for TT genotype, P<0.001). Plasma efavirenz concentration >4 mg/L was noted in 38 (22.2%) patients, which was associated with a lower weight (per 10-kg increase, odds ratio, 0.52; 95% confidence interval, 0.33-0.83) and GT or TT genotype (odds ratio, 4.35; 95% confidence interval, 1.97-9.59) in multivariate analysis.

Conclusions: Despite combination with rifampicin, sufficient plasma efavirenz concentrations can be achieved in HIV-infected Taiwanese with TB who receive efavirenz 600 mg daily. Carriage of CYP2B6 516 GT and TT genotypes and a lower weight are associated with higher plasma efavirenz concentrations.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Plasma efavirenz concentrations of HIV-infected patients with (n = 18) and without taking rifampicin (n = 153).
Dash lines indicate the target plasma concentrations of efavirenz for wild-type HIV-1 isolate.
Figure 2
Figure 2. Plasma efavirenz concentrations of 171 HIV-infected patients with different genotypes of CYP2B6 G516T polymorphisms.
Dash lines indicate the target plasma concentrations of efavirenz for wild-type HIV-1 isolate.
Figure 3
Figure 3. Relationship between efavirenz plasma concentrations (mg/L) and body weight (kg).
Triangles indicate cases with concurrent rifampicin use, and circles indicate cases without taking rifampicin.
See this image and copyright information in PMC

References

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