Efavirenz in the therapy of HIV infection.

Efavirenz in the therapy of HIV infection.
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Efavirenz在HIV感染的治疗中。

DOI:
10.1517/17425250903483207
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发表时间:
2010-01
影响因子:
4.3
通讯作者:
van den Anker JN
van den Anker JN
中科院分区:
医学2区
文献类型:
--
作者:
Rakhmanina NY;van den Anker JN

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使用第一代非核苷类逆转录酶抑制剂(NNRTI) efavirenz (EFV)作为一线抗逆转录病毒治疗的一个组成部分已被全世界接受。EFV是目前市场上唯一一种与恩曲他滨和富马酸替诺福韦二吡酯联合使用的单片抗逆转录病毒药物,每日一次。本文综述了依非韦伦的有效性和安全性数据以及药物遗传学在EFV暴露中的作用。对已发表的关于依非韦伦的文章和会议报告进行了回顾。CYP2B6基因多态性影响EFV的代谢。位置516的CYP2B6 G to T多态性已被证明与血浆浓度升高和EFV的神经毒性增加有关,而野生型基因型与EFV的亚治疗浓度有关,可能导致病毒耐药性的发展。与西班牙人、欧洲人和亚洲人相比,这种多态性在撒哈拉以南非洲人和非洲裔美国人中明显更高。CYP2B6多态性在EFV暴露中的重要性表明,需要前瞻性临床研究来评估基因型驱动剂量调整在不同血统人群中的效用。
The use of the first generation non-nucleoside reverse transcriptase inhibitor (NNRTI) efavirenz (EFV) as a component of first-line antiretroviral therapy has been accepted worldwide. EFV is the only antiretroviral agent currently on the market that has been combined with emtricitabine and tenofovir disoproxil fumarate in a single tablet and administered once-daily. This article reviews efficacy and safety data on efavirenz and the role of pharmacogenetics in EFV exposure. Published articles and conference presentations on efavirenz are reviewed. CYP2B6 genetic polymorphisms influence the metabolism of EFV. The CYP2B6 G to T polymorphism at position 516 is have been shown to be associated with elevated plasma concentrations and an increase in neurotoxicity of EFV, while the wild-type genotype has been associated with sub-therapeutic concentrations of EFV, potentially leading to the development of viral resistance. This polymorphism is significantly higher in Sub-Saharan Africans and African Americans as compared to Hispanic, European and Asian populations. The significance of CYP2B6 polymorphism in EFV exposure indicates the need for prospective clinical studies to evaluate the utility of genotype-driven dose adjustments in populations of diverse descent.
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