Jornal de Farmacogenômica e Farmacoproteômica

Abstrato

Integrating HIV-1 Pharmacogenomics into the Universal Coverage Health- Care System in Thailand: From Scientific Evidence to Policy

Wasun Chantratita, Soranun Chantarangsu, Sasisopin Kiertiburanakul, Somnuek Sungkanuparph, Angkana Charoenyingwattana and Surakameth Mahasirimongkol

In addition to the direct effect adverse drug reactions (ADRs) have on increased morbidity and mortality, their indirect impact on antiretroviral adherence and subsequent drug resistance is a major problem for HIV health services in a resource-limited setting. ADR is a major factor contributing to the interruption of antiretroviral intake in patients with good adherence to highly active antiretroviral therapy (ART). Antiretroviral non-adherence results in viral drug resistance, which derails antiretroviral effectiveness and causes higher costs for complicated treatment regimens; a burden that is more significant in resource-limited countries. Moreover, the costlier second-line treatment regimens (2-9 times higher in price than first-line regimens) are unaffordable for individual or government agencies in developing countries. This situation forms the basis for development of a pharmacogenomics initiative in Thailand, with special focus on HIV. The first target is to improve the prescription algorithm by personalizing the initial drug regimen; increasing the regimens efficacy; and simultaneously avoiding ADR. The ultimate aim of this initiative is to minimize the cost of ART for the public health system by incorporating research findings. Integrating HIV-1 pharmacogenetic screening tests into Thailand’s universal health-care system is a major challenge for the future and, if successfully implemented, they will eventually benefit both individuals and society.