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

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