Pharmacogenetics in HIV therapy: a review of key biomarkers, regulatory annotations, and clinical dosing guidelines

Introduction Pharmacogenetics is pivotal in modern HIV management, facilitating the transition from the traditional “one-size-fits-all” model toward personalized precision medicine. By analyzing how unique genetic profiles influence pharmacological responses, clinicians can maximize therapeutic efficacy while minimizing toxicities and adverse drug reactions. Given the high interindividual variability in antiretroviral drug exposure and the necessity for lifelong treatment, identifying key genetic biomarkers is essential to optimize patient safety, treatment adherence, and overall quality of life.Areas covered This narrative review evaluates major gene-drug associations in HIV therapy, focusing on HLA-B * 57:01 for abacavir, UGT1A1 for atazanavir and dolutegravir, and CYP2B6 for efavirenz. The research includes an exhaustive review of pharmacogenomic databases (e.g. ClinPGx), regulatory agency labels (FDA, EMA, Swissmedic, HC-SC, PMDA), and clinical guidelines from CPIC and DPWG.Expert opinion/commentary Integrating pharmacogenetics into clinical practice significantly improves patient safety and treatment adherence. While HLA-B * 57:01 screening is widely implemented, barriers remain for other markers, including logistical challenges and the lack of genomic representation for African and Latin American populations. Clinicians must utilize evidence-based resources and remain updated on this evolving field to effectively tailor antiretroviral regimens and practice precision medicine.