DNA Test For Med Metabolism

[tednlou2]

I was at a non-HIV doc yesterday.  Before I left, they said they wanted me to participate in this DNA test.  I was confused what they were wanting.  I was told it was an DNA test to test my genetic enzymes, that metabolize medications.  I was told some are poor metabolizers, some are normal, and some are fast metabolizers.  They said this could help determine whether someone needs less, the same, or more of a medication.  Or, whether a med doesn't really work at all for you. 

So, I had my cheek swabbed.  After I left, I did feel I should have asked more questions.  I did the test having no idea how my DNA could be used for other things.  I should have asked more questions and an agreement that it would only be used for the purpose stated.  I didnt even have to sign a consent form, but I digress.  My partner joked I've freely given loads of DNA, without worrying how it would be used..lol.

I've always thought people probably process meds differently, and not just based on weight or sex.  I began wondering what implications this could have for HIV prescribing.  We've seen people frustrated they are having a hard time getting UD, even months after starting therapy.  Others complain of side-effects. 

I'm curious what your thoughts are on this?  If someone is a poor metabolizer, could this be responsible for taking a long time to become UD?  I mean, would a poor metabolizer still have enough med to not develop resistance, but just take longer to become undetectable?  Would a higher dosage benifit them?  And, could a rapid metabolizer get too much of the med, which may be responsible for side-effects?  I am curious whether a test like this could allow patients to adjust their dosage to fit them?  I realize many HIV meds don't have various dosages, like you would have for Prozac, for example.  Not being on meds, I'm still not that familiar with the fixed dosages of HIV meds.  Or, would this not be of value when it comes to HIV meds, because HIV and the meds just work so differently? 

Of course, you may find this totally unfounded science and just a money scheme.  I was told my insurance would pay for it, so I assumed there must be enough science behind it.  We know insurance companies don't cover things, that are especially questionable.  I've just started to research it.

http://www.consumer-health.com/services/NewGeneticTestsHelpDoctorsPrescribetheRightMedicineforYou.php

[newt]

hmmm...

On balance, useless for HIV meds.

The test looks at some liver pathways that break down meds (and other things) and one of these it tests for is the one that is affected by Norvir. Which, as we know, boosts nearly everything that goes through the liver.

The test can't help you now to adjust your HIV meds dose, or indeed any other drugs that your HIV meds might affect, the science isn't there.

The practical way to test drug levels is via a test called therapeutic drug monitoring, which measure how long it takes to a maximum high, and how long it takes to a non-therapeutic low, for a dose of medicine in your actual body (via a blood draw or two).

This said, in future, yes these tests will be useful, but there need to be studies to show, eg this gene means use less/more. There are none for HIV meds at present, apart from some small scale basic science investigations. << for example, genetic propensity to have over high efavirenz levels can be tested at a research laboratory, but the test isn't validated for general clinical use

- matt