Роль фармакогенетики в безопасности и эффективности терапии ингибиторами протеаз ВИЧинфицированных пациентов

Сегодня продолжительность жизни людей с ВИЧ-инфекцией, получающих антиретровирусную терапию, сопоставима с продолжительностью жизни людей без данной патологии, в результате чего ВИЧ-инфекция превратилась из опасного для жизни заболевания в хроническое, поддающееся лечению и требующее пожизненной терапии, хотя и неизлечимое состояние. По мере увеличения продолжительности жизни пациентов с ВИЧ-инфекцией возникают уникальные проблемы, которые снижают их качество жизни. Снижение качества жизни пациентов с ВИЧ-инфекцией связано с длительным приёмом антиретровирусных препаратов, политерапией при сопутствующих заболеваниях. Все эти факторы могут способствовать повышению риска развития нежелательных лекарственных реакций и снижению эффективности, что может существенно повлиять на самочувствие пациента, снизить качество жизни и приверженность к терапии. В целом представляется, что будущая стратегия, направленная на контроль ВИЧ и профилактику СПИДа, потребует подавления репликации вируса при минимизации токсичности и нарушения функций органов. Ряд проведённых исследований указывают на общую критическую роль мембранных транспортёров, отвечающих за транспорт и всасывание, ферментов системы цитохрома, отвечающих за метаболизм лекарственного препарата. Поэтому генетические различия в метаболизме и транспортировке лекарств могут способствовать межиндивидуальным вариациям в результатах лечения. В настоящем обзоре будут рассмотрены и оценены доказательства наличия фармакогенетических маркеров в геноме человека, участвующих в метаболизме и распределении антиретровирусных препаратов ингибиторов протеазы лопинавира и ритонавира в комплексной антиретровирусной терапии.

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