Antiretroviral Therapy and Communities of Color

Chapter

Abstract

The current HIV treatment guidelines from both the DHHS and IAS indicate that the best choices for first-line therapy include either efavirenz (EFV) or a ritonavir-boosted protease inhibitor combined with a fixed dose combination nucleoside backbone (Table 1).1,2 These recommendations have evolved from a long list of clinical trials, which have shown these regimens to be very effective in suppressing HIV replication and allowing immune preservation/restoration in both the short and long term. There is little in the published literature to suggest that the treatment of choice for treatment-naïve patients should be determined by the patient’s race or ethnic background. Several studies have examined the effect of race on treatment outcome with mixed results. Some studies have demonstrated that blacks (and in some cases Hispanics) have lower treatment response rates than whites while others have suggested comparable outcomes given comparable treatment access. This chapter will discuss the recommendations for initial therapy in HIV-infected individuals, review the literature on disparities in treatment response to HIV therapies, and discuss possible contributing factors that drive these disparities.

References

  1. 1.
    Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. January 29, 2008; 1–128. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed April 2008
  2. 2.
    Hammer SM, Saag MS, Schechter M, et al. Treatment for adult HIV infection: 2006 recommendations of the International AIDS society-USA panel. JAMA 2006;296:827–843PubMedCrossRefGoogle Scholar
  3. 3.
    Sustiva (Efavirenz) package insertGoogle Scholar
  4. 4.
    Atripla (Efavirenz/tenofovir/emtricitabine) package insertGoogle Scholar
  5. 5.
    Taylor S, Allen S, Fidler S, White D, Gibbons S, Fox J, Clarke J, Weber J, Cane P, Wade A, Smit E, Back D. Stop study: after discontinuation of efavirenz, plasma concentrations may persist for 2 weeks or longer. Program and Abstracts of 11th Conference on Retroviruses and Opportunistic Infections, San Francisco, CA, February 8–11, 2004; Abstract 131Google Scholar
  6. 6.
    Haas D, Ribaudo H, Kim R, et al. Pharmacogenetics of efavirenz and central nervous system side effects: an adult AIDS clinical Trials group study. AIDS 2004; 16:2391–2400Google Scholar
  7. 7.
    Little SJ, Holte S, Routy JP, Daar ES, Markowitz M, Collier AC, Koup RA, Mellors JW, Connick E, Conway B, Kilby M, Wang L, Whitcomb JM, Hellmann NS, Richman DD. Antiretroviral-drug resistance among patients recently infected with HIV. N Engl J Med 2002 347: 385–394PubMedCrossRefGoogle Scholar
  8. 8.
    Shet A, Berry L, Mohri H, Mehandru S, Chung C, Kim A, Jean-Pierre P, Hogan C, Simon V, Boden D, Markowitz M. Tracking the prevalence of transmitted antiretroviral drug-resistant HIV-1: a decade of experience. J Acquir Immune Defic Syndr 2006 41(4):439–446PubMedCrossRefGoogle Scholar
  9. 9.
    Paredes R., Lalama C., Ribaudo H., et al. Presence of minor populations of Y181C mutants detected by allele-specific PCR and risk of efavirenz failure in treatment-naïve patients: results of an ACTG 5095 case-cohort study. [Abstract #83]. Paper presented at the 15th Conference on Retroviruses and Opportunistic Infections. Boston: February 3-6, 2008Google Scholar
  10. 10.
    Weinstock HS, Zaidi I, Heneine W, Bennett D, Garcia-Lerma JG, Douglas JM Jr, LaLota M, Dickinson G, Schwarcz S, Torian L, Wendell D, Paul S, Goza GA, Ruiz J, Boyett B, Kaplan JE. The epidemiology of antiretroviral drug resistance among drug-naive HIV-1-infected persons in 10 US cities. J Infect Dis 2004; 189(12): 2174–2180PubMedCrossRefGoogle Scholar
  11. 11.
    Fundaro C, Genovese O, Rendeli C, Tamburrini E, Salvaggio E. Myelomeningocele in a child with intrauterine exposure to efavirenz. AIDS 2002; 16(2): 299–300PubMedCrossRefGoogle Scholar
  12. 12.
    van Leth F, Phanuphak P, Ruxrungtham K, Baraldi E, Miller S, Gazzard B, Cahn P, Lalloo U, van der Westhuizen I, Malan D. Comparison of first-line antiretroviral therapy with regimens including nevirapine, efavirenz, or both drugs, plus stavudine and lamivudine: a randomised open-label trial, the 2NN Study. Lancet 2004; 363(9417): 1253–1263PubMedCrossRefGoogle Scholar
  13. 13.
    Virammune (Nevirapine) [package insert]. Boehringer Ingelheim Pharmaceuticals, Inc. Ridgefield, CT. Revised November 2008.Google Scholar
  14. 14.
    Norvir (ritonavir) [package insert]. Abbott Laboratories. Ridgefield, CT. Revised October 2008.Google Scholar
  15. 15.
    Walmsley S, Bernstein B, King M, Arribas J, Beall G, Ruane P, Johnson M, Johnson D, Lalonde R, Japour A, Brun S, Sun E, the M98–863 Study Team. Lopinavir-ritonavir versus nelfinavir for the initial treatment of HIV infection. N Engl J Med 2002 346: 2039–2046PubMedCrossRefGoogle Scholar
  16. 16.
    Cohen C, Nieto-Cisneros L, Zala C, Fessel WJ, Gonzalez-Garcia J, Gladysz A, McGovern R, Adler E, McLaren C, on behalf of the BMS AI424–043 Study Group. Comparison of atazanavir with lopinavir/ritonavir in patients with prior protease inhibitor failure: a randomized multinational trial. Curr Med Res Opin 2005; 21(10): 1683–1692PubMedCrossRefGoogle Scholar
  17. 17.
    Gathe JC Jr, Ive P, Wood R, Schurmann D, Bellos N, DeJesus E, Gladysz A, Garris C, Yeo J. SOLO: 48-week efficacy and safety comparison of once-daily fosamprenavir/ritonavir versus twice-daily nelfinavir in naive HIV-1-infected patients. AIDS 2004; 18(11): 1529–1537PubMedCrossRefGoogle Scholar
  18. 18.
    Kempf DJ, Isaacson JD, King MS, Brun SC, Xu Y, Real K, Bernstein BM, Japour AJ, Sun E, Rode RA. Identification of genotypic changes in human immunodeficiency virus protease that correlate with reduced susceptibility to the protease inhibitor lopinavir among viral isolates from protease inhibitor-experienced patients. J Virol 2001 75: 7462–7469PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Kaletra (lopinavir/ritonavir) [package insert]. Abbott Laboratories. Ridgefield, CT. Revised July 2007.Google Scholar
  20. 20.
    Riddler SA, Haubrich R, DiRienzo AG, Peeples L, Powderly WG, Klingman KL, Garren KW, George T, Rooney JF, Brizz B, Lalloo UG, Murphy RL, Swindells S, Havlir D, Mellors JW, the AIDS Clinical Trials Group Study A5142 Team. Class-sparing regimens for initial treatment of HIV-1 infection. N Engl J Med 2008 358: 2095–2106PubMedCrossRefGoogle Scholar
  21. 21.
    Reyataz (Atazanavir) [package insert]. Princeton NJ. Bristol Myers Squibb. September 2008.Google Scholar
  22. 22.
    Molina J., Andrade-Villanueva J., Echevarria J., Efficacy and safety of once-daily atazanavir/ritonavir compared to twice-daily lopinavir/ritonavir, each in combination with tenofovir and emtricitabinein ARV-naive HIV-1-infected subjects: The CASTLE study, 48-week results. [Abstract #37]. Paper presented at the 15th Conference on Retroviruses and Opportunistic Infections. Boston: February 3-6, 2008Google Scholar
  23. 23.
    Lexiva (Fosamprenavir) [package insert]. Research Triangle Park, NC. GlAxoSmithKline. Cambridge MA. Vertex Pharmaceuticals, Inc. October 2008.Google Scholar
  24. 24.
    Eron J Jr, Yeni P, Gathe J Jr, Estrada V, DeJesus E, Staszewski S, Lackey P, Katlama C, Young B, Yau L, Sutherland-Phillips D, Wannamaker P, Vavro C, Patel L, Yeo J, Shaefer M; KLEAN study team. The KLEAN study of fosamprenavir-ritonavir versus lopinavir-ritonavir, each in combination with abacavir-lamivudine, for initial treatment of HIV infection over 48 weeks: a randomised non-inferiority trial. Lancet 2006; 368(9534): 476–482PubMedCrossRefGoogle Scholar
  25. 25.
    Smith KY, Weinberg WG, Dejesus E, Fischl MA, Liao Q, Ross LL, Pakes GE, Pappa KA, Lancaster CT; the ALERT (COL103952) Study Team. Fosamprenavir or atazanavir once daily boosted with ritonavir 100 mg, plus tenofovir/emtricitabine, for the initial treatment of HIV infection: 48-week results of ALERT. AIDS Res Ther 2008; 5(1): 5PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Prezista (darunavir) [package insert]. Tibotec Therapeutics, Division of Ortho Biotech Products, L.P., Raritan NJ. June 2006.Google Scholar
  27. 27.
    Clotet B, Bellos N, Molina JM, et al. Efficacy and safety of darunavir-ritonavir at week 48 in treatment-experienced patients with HIV-1 infection in POWER 1 and 2: a pooled subgroup analysis of data from two randomised trials. Lancet 2007 Apr 7; 369(9568):1169–1178.Google Scholar
  28. 28.
    Ortiz R, DeJesus E, Khanlou H, et al. Efficacy and safety of once-daily darunavir/ritonavir versus lopinavir/ritonavir in treatment-naïve HIV-1-infected patients at week 48. AIDS 2008; 588 22:1389–1397.Google Scholar
  29. 29.
    Truvada (tenofovir+emtricitabine) [package insert]. Gilead Sciences. November 2008.Google Scholar
  30. 30.
    Epzicom (abacavir+lamivudine) [package insert]. Research Triangle Park, NC. GlAxo-SmithKline. March 2009.Google Scholar
  31. 31.
    De Silva TI, Post FA, Griffin MD, Cockrell DH. HIV-1 infection and the kidney: an evolving challenge in HIV medicine. Mayo Clin Proc 2007; 82: 1103–1116PubMedCrossRefGoogle Scholar
  32. 32.
    Lucas GM, Mehta SH, Atta MG,. End-stage renal disease and chronic kidney disease in a cohort of African-American HIV-infected and at-risk HIV-seronegative participants followed between 1988 and 2004. AIDS 2007; 21: 2435–2443PubMedCrossRefGoogle Scholar
  33. 33.
    Gardner LI, Klein RS, Szczech LA,. Rates and Risk Factors for Condition Specific Hospitalizations in HIV infected and Uninfected Women. JAIDS. 2003; 32: 203–209PubMedGoogle Scholar
  34. 34.
    Atta MG and Fine DM. Editorial comment: tenofovir nephrotoxicity-the disconnect between clinical trials and real-world practice. The AIDS Reader 2009; 19(3): 118-119PubMedGoogle Scholar
  35. 35.
    Gallant JE, Staszewski S, Pozniak AL,. Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naïve patients: a 3-year randomized trial. JAMA 2004; 292: 191–201PubMedCrossRefGoogle Scholar
  36. 36.
    Izzedine H, Hulot JS, Vittecoq D, et al. Long-term renal safety of tenofovir disoproxil fumarate in antiretroviral-naïve HIV-1-infected patients: data from a double-blind randomized active-controlled multicentre study. Nephrol Dial Transplant 2005; 20:743–746PubMedCrossRefGoogle Scholar
  37. 37.
    Szczech LA. Tenofovir nephrotoxicity: focusing research questions and putting then into clinical context. J Infect Dis 2008; 197: 7–9PubMedCrossRefGoogle Scholar
  38. 38.
    Becker S., Balu R., Fusco J., Beyond serum creatinine: identification of renal insufficiency using glomerular filtration: implications for clinical research and care. [Abstract #819]. Paper presented at the 12th Conference on Retroviruses and Opportunistic Infections. Boston: February 22-25, 2008Google Scholar
  39. 39.
    Symonds W, Cutrell A, Edwards M,. Risk factor analysis of hypersensitivity reactions to abacavir. Clin Ther 2002; 24(4): 565–573PubMedCrossRefGoogle Scholar
  40. 40.
    Hughes AR, Spreen WR, Mosteller M, et al. Pharmacogenetics of hypersensitivity to abacavir: from PGx hypothesis to confirmation to clinical utility. The Pharmacogenomics Journal 2008; 8(6):365-374Google Scholar
  41. 41.
    Faruki H, Heine U, Brown T, Koester R, Lai-Goldman M. HLA-B*5701 clinical testing: early experience in the United States. Pharmacogenet Genomics 2007; 17: 857–860PubMedCrossRefGoogle Scholar
  42. 42.
    Mallal S, Phillips E, Carosi G,. HLA-B*5701 screening for hypersensitivity to abacavir. N Engl J Med 2008; 358: 568–579PubMedCrossRefGoogle Scholar
  43. 43.
    Saag M, Balu R, Bachman P, et al. High sensitivity of HLA-B*5701 in whites and blacks in immunologically confirmed cases of hypersensitivity. Clin Infect Dis 2008 (in press)Google Scholar
  44. 44.
    Smith K., Fine D., Patel P., et al. Efficacy and safety of abacavir/lamivudine compared to tenofovir/emtricitabine in combination with once-daily lopinavir/ritonavir through 48 weeks in the HEAT Study. [Abstract #774]. Paper presented at the 15th Conference on Retroviruses and Opportunistic Infections. Boston: February 3-6, 2008Google Scholar
  45. 45.
    DAIDS press release. February 22, 2008Google Scholar
  46. 46.
    Gallant JE, DeJesus E, Arribas JR, Pozniak AL, Gazzard B, Campo RE, Lu B, McColl D, Chuck S, Enejosa J, Toole JJ, Cheng AK, the Study 934 Group. Tenofovir DF, emtricitabine, and efavirenz vs. zidovudine, lamivudine, and efavirenz for HIV. N Engl J Med 2006 354: 251–260PubMedCrossRefGoogle Scholar
  47. 47.
    DeJesus E, Herrera G, Teofilo E, Gerstoft J, Buendia CB, Brand JD, Brothers CH, Hernandez J, Castillo SA, Bonny T, Lanier ER, Scott TR, for the CNA30024 Study Team. Abacavir versus zidovudine combined with lamivudine and efavirenz, for the treatment of antiretroviral-naïve HIV-Infected adults. Clin Infect Dis 2004; 39(7): 1038–1046PubMedCrossRefGoogle Scholar
  48. 48.
    D:A:D Study Group. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration. Lancet 2008 Apr 26; 371(9622), 1417–1426.Google Scholar
  49. 49.
    Lundgren J, et al. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the SMART study. XVII International AIDS Conference, Mexico City, abstract THAB0305, 2008.Google Scholar
  50. 50.
    McComsey G, Smith KY, Patel P, et al. Similar reductions in markers of inflammation and endothelial activation after initiation of abacavir/lamivudine or tenofovir/emtricitabine: The HEAT Study. Program and abstracts of the 16th Conference on Retroviruses and Opportunistic Infections; February, 2009; Montreal, Canada. Abstract 732.Google Scholar
  51. 51.
    Cutrell, et al. Is abacavir (ABC)-containing combination antiretroviral therapy (CART) associated with myocardial infarction (MI)? No association identified in pooled summary of 54 clinical trials. XVII International AIDS Conference, Mexico City, abstract WEAB0106, 2008.Google Scholar
  52. 52.
    Centers for Disease Control and Prevention. Late versus early testing of HIV – 16 Sites, Unites States, 2002–2003. MMWR Morb Mortal Wkly Rep 2003; 52: 581–586Google Scholar
  53. 53.
    McNaghten A, Hanson DL, Kellerman S, et al. Factors associated with immunologic stage at which patients initiate antiretroviral therapy. Program and abstracts of the 9th Conference on Retroviruses and Opportunistic Infections. February 24–28, 2002, Seattle, WA, Abstract 473-MGoogle Scholar
  54. 54.
    CDC. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Morb Mortal Wkly Rep 2006; 55(RR14): 1–17Google Scholar
  55. 55.
    Anastos K, Schneider MF, Gange SJ,. The association of race, sociodemographic, and behavioral characteristics with response to highly active antiretroviral therapy in women. J Acquir Immune Defic Syndr 2005; 39(5): 537–544PubMedGoogle Scholar
  56. 56.
    Lucas GM, Chaisson RE, Moore RD. Highly active antiretroviral therapy in a large urban clinic: risk factors for virologic failure and adverse drug reactions. Ann Intern Med 1999; 131: 81–87PubMedCrossRefGoogle Scholar
  57. 57.
    Lucas GM, Chaisson RE, Moore RD. Survival in an urban HIV-1 clinic in the era of highly active antiretroviral therapy: a 5-year cohort study. J Acquir Immune Defic Syndr 2003; 33(3): 321–328PubMedCrossRefGoogle Scholar
  58. 58.
    S Jensen-Fangel, L Pedersen, C Pedersen et al. The effect of race/ethnicity on the outcome of highly active antiretroviral therapy for human immunodeficiency virus type-1 infected patients. Clin Infect Dis 2002; 35: 1541–1548PubMedCrossRefGoogle Scholar
  59. 59.
    Silverberg MJ, Wegner SA, Milazzo MJ, et al. Effectiveness of highly-active antiretroviral therapy by race/ethnicity. AIDS 2006, 20: 1531–1538PubMedCrossRefGoogle Scholar
  60. 60.
    Hartzell JD, Spooner K, Howard R,. Race and mental health diagnosis are risk factors for highly active antiretroviral therapy failure in a military cohort despite equal access to care. J Acquir Immune Defic Syndr 2007; 44(4): 411–416PubMedCrossRefGoogle Scholar
  61. 61.
    Gebo KA, Fleishman JA, Conviser R, et al. Racial and gender disparities in receipt of highly active antiretroviral therapy persist in a multistate samples of HIV patients in 2001. J Acquir Immune Defic Syndr 2005; 38:96–103PubMedCrossRefGoogle Scholar
  62. 62.
    Cunningham WE, Markson LE, Andersen RM, et al. Prevalence and predictors of highly active antiretroviral therapy use in patients with HIV infection in the United States. HCSUS Consortium. HIV Cost and Services Utilization Survey. J Acquir Immune Defic Syndr 2000; 25: 115–123PubMedCrossRefGoogle Scholar
  63. 63.
    Shapiro MF, Morton SC, McCaffrey DF,. Variations in the care of HIV-infected adults in the United States: results from the HIV Cost and Services Utilization Study. JAMA 1999; 281: 2305–2315PubMedCrossRefGoogle Scholar
  64. 64.
    Wegner S, Vahey M, Dolan M, et al. Racial differences in clinical efficacy of efavirenz-based antiretroviral therapy. Program and abstracts of the 9th Conference on Retroviruses and Opportunistic Infections. February 24–28, 2002, Seattle, WA, Abstract 428Google Scholar
  65. 65.
    Gulick RM, Ribaudo HJ, Shikuma CM,. Triple-nucleoside regimens versus efavirenz-containing regimens for the initial treatment of HIV-1 infection. N Engl J Med 2004; 350: 1850–1861PubMedCrossRefGoogle Scholar
  66. 66.
    Schackman BR, Ribaudo HJ, Krambrink A,. Racial differences in virologic failure associated with adherence and quality of life on efavirenz-containing regimens for initial HIV therapy: results of ACTG A5095. J Acquir Immune Defic Syndr 2007; 46(5): 547–554PubMedCrossRefGoogle Scholar
  67. 67.
    Ribaudo HJ, Haas D, Tierney C. Pharmacogenetics of plasma efavirenz exposure after treatment discontinuation: an Adult AIDS Clinical Trials Group Study. Clin Infect Dis 2006; 42(3): 401–407PubMedCrossRefGoogle Scholar
  68. 68.
    Moore R, Keruly J, Gebo K, Lucas G. Racial differences in efavirenz discontinuation in clinical practice. In: Abstracts of the 12th Conference on Retroviruses and Opportunistic Infections. 2005, Boston, MA, Abstract 619Google Scholar
  69. 69.
    Wandel C, Witte JS, Hall JM, Stein CM, Wood AJ, Wilkinson GR. Cyp3a in African American and European American men: population differences and functional effect of CYP3a4*1B5′-promoter region polymorphism. Clin Pharmacol Ther 2000; 68: 82–91PubMedCrossRefGoogle Scholar
  70. 70.
    Wan YJ, Poland RE, Han G,. Analysis of the CYP2D6 gene polymorphism and enzyme activity in African-Americans in Southern California. Pharmacogenetics 2001; 11: 489–499PubMedCrossRefGoogle Scholar
  71. 71.
    Schaeffeler E, Eichelbaum M, Brinkmann U,. Frequency of C3435T polymorphism of MDR1 gene in African people. Lancet 2001; 358: 383–384PubMedCrossRefGoogle Scholar
  72. 72.
    Ameyaw MM, Regateiro F, Li T,. MDR 1pharmecogenetics: frequency of C3435T mutation in Exon 26 is significantly influenced by ethnicity. Pharmacogenetics 2001; 11: 217–221PubMedCrossRefGoogle Scholar
  73. 73.
    Kim RB, Leake BF, Choo EF,. Identification of functionally variant MDR 1 alleles among European Americans and African Americans. Clin Pharmacol Ther 2001; 7: 189–199CrossRefGoogle Scholar
  74. 74.
    Stein CM, Sadeque AJ, Murray JJ, Wandel C, Kim RB, Wood AJ. Cyclosporine pharmacokinetics and pharmacodynamics in African American and white subjects. Clin Pharmacol Ther 2001; 69: 317–323PubMedCrossRefGoogle Scholar
  75. 75.
    Min DI, Lee M, Ku YM, Flanigan M. Gender-dependent racial difference in disposition of cyclosporine among healthy African American and white volunteers. Clin Pharmacol Ther 2000; 68: 478–486PubMedCrossRefGoogle Scholar
  76. 76.
    Selzentry (Maraviroc) package insertGoogle Scholar
  77. 77.
    Samson M, Libert F, Doranz BJ,. Resistance to HIV-1 infection in Caucasian individuals bearing mutant alleles of the CCR-5 chemokine receptor gene. Nature 1996; 382: 722–725PubMedCrossRefGoogle Scholar
  78. 78.
    Dean M, Carrington M, Winkler C,. Genetic restriction of HIV-1 infection and progression to AIDS by a deletion allele of the CKR5 structural gene. Science 1996; 273: 1856–1862PubMedCrossRefGoogle Scholar
  79. 79.
    Tang J, Shelton B, Makhatadze NJ, Zhang Y, Schaen M, Louie LG, Goedert JJ, Seaberg EC, Margolick JB, Mellors J, Kaslow RA. Distribution of chemokine receptor CCR2 and CCR5 genotypes and their relative contribution to human immunodeficiency virus type 1 (HIV-1) seroconversion, early HIV-1 RNA concentration in plasma, and later disease progression. J Virol 2002; 76(2): 662–672PubMedCentralPubMedCrossRefGoogle Scholar
  80. 80.
    Martinson JJ, Chapman NH, Rees DC, Liu YT, Clegg JB. Global distribution of the CCR5 gene 32–base pair deletion. Nat Genet 1997; 16: 100–103PubMedCrossRefGoogle Scholar
  81. 81.
    Philpott S, Burger H, Tarwater PM,. CCR2 genotype and disease progression in a treated population of HIV type 1-infected women. Clin Infect Dis 2004; 39(6): 861–865PubMedCentralPubMedCrossRefGoogle Scholar
  82. 82.
    Zimmerman PA, Buckler-White A, Alkhatib G, Spalding T, Kubofcik J, Combadiere C, Weissman D, Cohen O, Rubbert A, Lam G, Vaccarezza M, Kennedy PE, Kumaraswami V, Giorgi JV, Detels R, Hunter J, Chopek M, Berger EA, Fauci AS, Nutman TB, Murphy PM. Inherited resistance to HIV-1 conferred by an inactivating mutation in CC chemokine receptor 5: studies in populations with contrasting clinical phenotypes, defined racial background, and quantified risk. Mol Med 1997; 3(1): 23–36PubMedCentralPubMedGoogle Scholar
  83. 83.
    Berkowitz DR, Alexander S, Bare C,. CCR5 and CXCR4-utilizing strains of human immunodeficiency virus type 1 exhibit differential tropism and pathogenesis in vitro. J Virol 1998; 72: 10108–10117PubMedCentralPubMedGoogle Scholar
  84. 84.
    Wilkin TJ, Zhaihui S, Kuritzkes DR, et al. HIV Type 1 Chemokine coreceptor use among antiretroviral-experienced patients screened for a clinical trial of a CCR5 inhibitor: AIDS Clinical Trial Group 5211. Clin Infect Dis 2007; 44Google Scholar
  85. 85.
    Raltegravir (Isentress) package insertGoogle Scholar
  86. 86.
    Fertrin KY, Gonçalves MS, Saad STO, et al. Frequencies of UDP-glucuronosyltransferase 1 (UGT1A1) gene promoter polymorphisms among distinct ethnic groups from Brazil. Am J Med Genet 2002; 108(2): 117–119PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Section of Infectious DiseasesRush University Medical CenterChicagoUS

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