Successful application of pharmacogenomic testing in the evaluation and management of a patient with human immunodeficiency virus and disseminated histoplasmosis

Kevin F. Hanna, Joshua P. Havens, Sara H. Bares

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To demonstrate the successful use of pharmacogenomic testing to specifically tailor antifungal treatment to the phenotype of a patient with human immunodeficiency virus (HIV) and disseminated histoplasmosis who had clinical progression while on itraconazole and subsequently had insufficient therapeutic drug levels of voriconazole. Case summary: We present the case of a patient with HIV and disseminated histoplasmosis with a persistently elevated serum Histoplasma capsulatum antigen and subtherapeutic levels of voriconazole. Pharmacogenomic testing revealed he was a CYP2C19 rapid metabolizer, thus explaining his persistent, subtherapeutic levels of voriconazole and prompting a change in therapy. Practice implications: Our case illustrates the importance of pharmacogenomic testing as a tool to evaluate subtherapeutic itraconazole or voriconazole levels, especially in patients with failed clinical or Histoplasmosis Ag response despite reporting full adherence to prescribed therapy.

Original languageEnglish (US)
Pages (from-to)e152-e155
JournalJournal of the American Pharmacists Association
Volume61
Issue number3
DOIs
StatePublished - May 1 2021

ASJC Scopus subject areas

  • Pharmacology (nursing)
  • Pharmacy
  • Pharmacology

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