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CPIC® Guideline for Atazanavir and UGT1A1

Most recent guideline publication:

Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for UGT1A1 and Atazanavir Prescribing (September 2015)

Updates since publication:

November 2017: UGT1A1*80 is in very high linkage disequilibrium with *28 and *37.  In the rare event that *80 is detected but *28 and *37 are not, there are not enough clinical data to predict metabolizer status with certainty. However, if only *80 is interrogated and the patient is heterozygous or homozygous for *80, an intermediate or poor metabolizer phenotype may be inferred, respectively. The UGT1A1 Allele Definition TableUGT1A1 Allele Functionality Table, and UGT1A1 Diplotype-Phenotype Table have been updated accordingly.

March 2017: Based on a recent paper (PMID 27967321), UGT1A1*60 allele function has changed to normal function (see UGT1A1 Allele Functionality Table).

Tables and figure provided in the main manuscript of the guideline:

Table 1. Assignment of likely UGT1A1 phenotypes based on genotypes
Figure 1. Cumulative incidence of time to bilirubin-associated discontinuation of atazanavir stratified by UGT1A1 genotype in AIDS Clinical Trials Group protocol A5257
Table 2. Recommended use of atazanavir (boosted with either ritonavir or cobicistat*) by UGT1A1 phenotype

Supplement to: Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for UGT1A1 and Atazanavir Prescribing (September 2015)

Tables and figures included in the supplementa or referenced in the guideline:

Supplemental Table S1. Commonly tested genotypes that constitute the * alleles for UGT1A1 For an updated version of this table see the UGT1A1 Allele Definition Table .
Supplemental Table S2. Association between allelic variants and UGT1A1 function for commonly tested alleles For an updated version of this table see the UGT1A1 Allele Functionality Table .
Supplemental Table S3a. Frequencies (%) of rs8175347 alleles in major race/ethnic groups For an updated version of this table see the UGT1A1 Frequency Table .
Supplemental Table S3b. Frequencies (%) of rs4148323 alleles in major race/ethnic groups For an updated version of this table see the UGT1A1 Frequency Table .
Supplemental Table S3c. Frequencies (%) of rs887827 alleles in major race/ethnic groups For an updated version of this table see the UGT1A1 Frequency Table .
Supplemental Table S4. Evidence linking genotype to phenotype
Supplemental Table S5. Drug(s) that pertain to this guideline
Supplemental Table S6. Gene(s) that pertain to this guideline For an updated version of this table see the UGT1A1 Gene Resource Mappingsb.
Supplemental Figure S1. UGT1A1 pharmacogenetic test result: clinical implementation workflow for EHR
Supplemental Figure S2. UGT1A1 genotype and atazanavir: point of care clinical decision support
Supplemental Table S7. Example implementation of this guideline for UGT1A1: pharmacogenetic diplotype/phenotype summary entries For an updated version of this table see the UGT1A1 Diplotype-Phenotype Tableb.
Supplemental Table S8. Example Implementation of this Guideline: Point of Care Clinical Decision Support

aSome of the tables included in the guideline may have been updated on-line, particularly to reflect newly described or newly characterized alleles. These include the gene-specific information tables (https://www.pharmgkb.org/page/pgxGeneRef) that support CPIC guidelines by providing information regarding star (*) allele definitions, allele function, allele frequency by major ethnic groups, translations of diplotype to phenotype, and gene resource mappings.

bThese resources support the adoption of CPIC guidelines into the electronic health record with clinical decision support and provide information that clinical implementers find helpful.