Acetylator phenotype and genotype in HIV-infected patients with and without sulfonamide hypersensitivity

William M. O'Neil, Rodger D. MacArthur, Marti J. Farrough, Mark A. Doll, Adrian J. Fretland, David W. Hein, Lawrence R. Crane, Craig K. Svensson

Research output: Contribution to journalArticle

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Abstract

Adverse reactions to sulfonamides occur at a higher frequency in patients infected with the human immunodeficiency virus (HIV) than noninfected patients. Some studies have suggested that patients with the slow acetylator phenotype are predisposed to these reactions, whereas other studies suggest that the slow acetylator genotype is not a predisposing factor. To rationalize these seemingly contradictory observations, the authors determined the N-acetyltransferase 2 (NAT2) genotype and phenotype in patients with and without a history of hypersensitivity reactions to sulfonamides. HIV-infected patients with a history of a delayed-type hypersensitivity reaction to trimethoprim-sulfamethoxazole were enrolled, along with a group of AIDS patients with no history of hypersensitivity (delayed or immediate). NAT2 phenotype was determined in both groups using dapsone, while the genotype was determined using a polymerase chain reaction-restriction fragment length polymorphism assay. Ten of 14 patients (71%) with a history of hypersensitivity exhibited the slow acetylator phenotype, while 8 of 14 patients (57%) without such a history exhibited this same phenotype (odds ratio [OR] = 1.9, 95% confidence interval [CI] = 0.4-9.0; p = 0.69, Fisher's Exact Test). While 9 of 14 patients (64%) with a history of hypersensitivity exhibited a slow acetylator genotype, only 4 of 14 patients (29%) without such a history exhibited this genotype (ns). There were more instances of discordance between deduced and actual phenotype in the nonhypersensitive patients (n = 4) than in the hypersensitive patients (n = 1). The reported higher frequency of the slow acetylator phenotype among patients with a history of hypersensitivity to sulfonamides does not appear to be explained by metabolic changes that would cause discordance between acetylator genotype and phenotype.

Original languageEnglish (US)
Pages (from-to)613-619
Number of pages7
JournalJournal of Clinical Pharmacology
Volume42
Issue number6
DOIs
StatePublished - Jan 1 2002

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Sulfonamides
Hypersensitivity
Genotype
HIV
Phenotype
Acetyltransferases
Delayed Hypersensitivity
History
Immediate Hypersensitivity
Dapsone
Sulfamethoxazole Drug Combination Trimethoprim
Restriction Fragment Length Polymorphisms
Causality
Acquired Immunodeficiency Syndrome
Odds Ratio

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Acetylator phenotype and genotype in HIV-infected patients with and without sulfonamide hypersensitivity. / O'Neil, William M.; MacArthur, Rodger D.; Farrough, Marti J.; Doll, Mark A.; Fretland, Adrian J.; Hein, David W.; Crane, Lawrence R.; Svensson, Craig K.

In: Journal of Clinical Pharmacology, Vol. 42, No. 6, 01.01.2002, p. 613-619.

Research output: Contribution to journalArticle

O'Neil, William M. ; MacArthur, Rodger D. ; Farrough, Marti J. ; Doll, Mark A. ; Fretland, Adrian J. ; Hein, David W. ; Crane, Lawrence R. ; Svensson, Craig K. / Acetylator phenotype and genotype in HIV-infected patients with and without sulfonamide hypersensitivity. In: Journal of Clinical Pharmacology. 2002 ; Vol. 42, No. 6. pp. 613-619.
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