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How pharmacogenomics can improve the lives of persons living with HIV
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By Jessica Fenske
Life with HIV typically means using any number of medications to control the virus. But not all medications are the same or act the same way in different people. Mayo researchers are zeroing in on a new test to help patients fine-tune their treatments.
While there is no cure for HIV, there are more than 30 different medications available to control the virus. These drugs can be lifesaving, but persons living with HIV still face a lifetime of potentially serious side effects.
As part of research supported by the Mayo Clinic Center for Individualized Medicine, a team led by Nathan Cummins, M.D., Infectious Diseases Research, is trying to figure out how to improve tests to identify which medications are the right fit for a person living with HIV.
A complicated disease
"HIV is a very complicated disease," Dr. Cummins says. "The biology of the virus is complicated, the disease affects multiple organ systems, and oftentimes the most vulnerable of populations are most affected."
The challenge of unraveling such a complex infection is part of what drew Dr. Cummins to a research career focused on HIV. Now he hopes that pharmacogenetics — the study of how genes affect a person's response to drugs — can improve the lives of those living with HIV by quickly identifying the best medicine for each individual.
It's a complicated process. Each medication has the potential for different drug-to-drug interactions, and multiple patients can take the same medication yet all experience different side effects.
"These differences make it difficult to figure out which drugs work best for each individual person," says Dr. Cummins. "What works well for one patient doesn’t always work well for another."
Finding the best medications for each individual often involves continuing to try different options until uncovering the combination of drugs with the fewest side effects.
"Because it looks at DNA, it’s a one-time test. DNA doesn't change, so once they have the results, they can use them for the rest of their lives." - Dr. Cummins
A broader test
The current standard of care for persons living with HIV is to test one gene for one particular HIV medication. But Dr. Cummins and his team are offering a broader, more comprehensive solution. The OneOme 22-gene RightMed pharmacogenomics panel tests 22 different genes for dozens of potential medications. It also tests their interactions with several other drugs.
In an initial clinical trial, 96 persons living with HIV completed the pharmacogenomics panel, and many received new clinical recommendations based on the results.
Each patient reviewed the test results with pharmacists Christina Rivera, Pharm.D., and John Zeuli, Pharm.D. The pharmacists helped explain why the patients may not have tolerated a medication in the past, what risks they have with current medications, and what side effects and drug-to-drug interactions they might have with future medications. With this information, patients and care teams can make decisions about changing medications or keeping a closer eye on potential risks.
The test results are also put in the patient's health record. This makes the information available for future decisions about medications, and the patient can share it with any clinician.
"Because it looks at DNA, it’s a one-time test," says Dr. Cummins. "DNA doesn't change, so once they have the results, they can use them for the rest of their lives."
Leading the way
"Mayo Clinic is one of the world leaders in introducing pharmacogenomics into practice," says Timothy Curry, M.D., Ph.D., a leader of clinical pharmacogenomics implementation in the Mayo Clinic Center for Individualized Medicine. "This pilot project demonstrates that individualized medicine can improve the way we care for patients."
With the initial pilot complete, Dr. Cummins and his team are working on additional pilots to expand the availability of the test and education, with the ultimate goal of making it a routine part of care for all persons living with HIV.
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