Pharmacogenetics in Tuberculosis-HIV Coinfected Populations: A Systematic Review of Genetic Variants Influencing Antiretroviral and Anti-Tuberculosis Drug Response

Pharmacogenetics is a concept designed to tailor medication based on genetic profile to improve efficacy and reduce adverse effects. This personalized strategy shows considerable potential for populations facing complicated therapeutic challenges, such as the coinfected Tuberculosis (TB)-HIV population. This systematic review analyses pharmacogenes related to antiretroviral and anti-tuberculosis medications in the TB-HIV population. An analysis of 39 included studies indicated that efavirenz and CYP2B6*6 are the most extensively researched antiretroviral therapy (ART) and gene, respectively. Isoniazid and N-acetyltransferase 2 (NAT2) are the most extensively researched anti-TB drug and gene, respectively. Nevertheless, many studies relied solely on observational research and the investigation of pharmacokinetic characteristics. Research evaluated both the drug concentration of individual gene-drug interactions and the interactions between medications based on their genotypes. The NAT2 slow acetylator genotype is associated with elevated isoniazid levels, consequently increasing efavirenz plasma concentrations. Arylacetamide deacetylase (AADAC) polymorphisms that increased rifapentine plasma levels could also reduce dolutegravir plasma concentrations. Specific genes linked to significant outcomes in TB-HIV populations, such as pregnane X receptor (PXR) g.24087C>T, which increased the mortality rate. Consequently, a holistic approach to pharmacogenetics in TB-HIV populations is essential, considering all drug-gene-disease interactions. High-quality research, including randomized controlled trials (RCTs), is necessary for the implementation of pharmacogenetic testing in TB-HIV populations before it can be widely adopted in clinical practice, which is currently lacking

• Population(s)
  • General HIV+ population
  • Other
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
• Engagement and Care Cascade
  • Treatment
• Co-infections
  • Tuberculosis
• Health Systems
  • Governance arrangements