How we live varies as much as our biological makeups; both affect the outcome of drug therapies.

OUR SOLUTION: Take into account all the factors that can influence a drug’s effectiveness for each individual — from genetic heritage and lifestyle to age and weight.

Illustration: Brian Stauffer

How can we treat chronic pain without fueling opioid addiction in women living with HIV?

As the pharmacist for the UCSF Women’s HIV Program, Jennifer Cocohoba, PharmD ’01, creates and monitors individualized drug treatment regimens for her HIV-positive patients, many of whom have been affected by traumatic life experiences such as homelessness, drug addiction, sexual assault, or physical abuse. They’re at high risk of developing chronic pain, both because of these traumas and because of the painful conditions — like neuropathy or avascular necrosis — caused by HIV or the drugs used to treat it.

Alarmed by these facts, and by the rising national incidence of prescription painkiller overdoses in women, Cocohoba and her UCSF School of Nursing colleague Yvette Cuca Bromberger, PhD ’13, MPH, set out to learn more about these patients and their relationships to opioids. They’re asking patients about their dependence on opioids, perceptions of the drugs’ risks, and attempts to reduce their opioid use. Armed with initial research data, they hope to then design and test interventions to promote safe use of opioids for effective pain relief, especially for women living with HIV.

Photos: Noah Berger (left); Elisabeth Fall (middle); Steve Babuljak (right)

How can we use existing TB medications more effectively in individual patients worldwide?

Tuberculosis (TB) is curable and preventable, according to the World Health Organization. But it still kills nearly 2 million people a year, making it the deadliest infectious disease in the world. Rada Savic, PhD, thinks those deaths are unnecessary — and she knows how to prevent them. For decades, health care providers have treated TB using a standard six-month regimen of a handful of antibiotics, but Savic’s research has shown that this one-size-fits-all approach doesn’t work for all patients. Those who need treatment for less than the standard six months often end up bedridden for a few extra months due to side effects. And those who need treatment for more than six months can end up with recurring bouts of infection, which are more likely to be drug resistant — and deadly.

Based on patient data already collected by clinics worldwide — like X-rays, bacterial culture results, age, and nutrition status — Savic is confident that health care providers can successfully implement an evidence-based treatment plan for every patient, tailoring medication dose and frequency to each individual case. She’s optimistic that by following this course, the world may soon eradicate TB, once and for all.

How can we leverage the unique genetic ancestry of each individual to better treat patients with asthma?

Variations in our genetic ancestry, as well as in the social and environmental factors we’re exposed to, can affect how vulnerable we are to disease. Our genetic ancestry can also influence the safety and effectiveness of drugs we’re prescribed. This is shockingly true of asthma — the most common chronic disease in children in the U.S. — and the medications used to treat it.

For the past 20 years, Esteban Burchard, MD, MPH, has been studying the causes of health disparities in children with asthma, focusing on Latino and African American children. In the U.S., Puerto Ricans and African Americans are three times more likely to die from asthma than Mexicans and non-Latino whites. In addition, they have the lowest response to albuterol, the most commonly prescribed asthma medication worldwide. Burchard, together with his School of Pharmacy colleagues Ryan Hernandez, PhD, and Nadav Ahituv, PhD, plus 12 other research teams from eight universities, set out to uncover why there are racial/ethnic differences in patients’ responses to albuterol. The group investigated the entire genomes of 1,441 Puerto Rican, African American, and Mexican children with asthma who responded either very well or very poorly to albuterol. They recently uncovered genetic variants that may explain some of the differences, a discovery that is helping to clear the path to personalizing asthma treatments for minority children.