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Navér L, Albert J, Carlander C, Gisslén M, Pettersson K, Soeria-Atmadja S, Sönnerborg A, Westling K, Yilmaz A, Pettersson K. Prophylaxis and treatment of HIV infection in pregnancy, Swedish guidelines 2024. Infect Dis (Lond) 2024:1-12. [PMID: 38805265 DOI: 10.1080/23744235.2024.2360029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
In May 2024, the Swedish Reference Group on Antiviral Therapy updated the guidelines on management of HIV infection in pregnancy. The most important recommendations and revisions were: (i) ART during pregnancy should be started as early as possible and continue after delivery; (ii) Suppressive ART should normally not be modified; (iii) The treatment target of HIV RNA <20 copies/ml remains; (iv) Dolutegravir/emtricitabine/tenofovir DF is the first-line drug combination also in pregnant women and women planning pregnancy; (v) There is no evidence of an increased risk of neural tube defects associated with dolutegravir; (vi) Mode of delivery for women with effective ART and HIV RNA <200 copies/ml should follow standard obstetric procedures; (vii) Caesarean section is recommended if HIV RNA ≥200 copies/ml; (viii) Scalp electrode, foetal blood sampling and/or vacuum delivery should be used on strict indications, but does not necessitate intensified infant prophylaxis; (ix) Management and mode of delivery in case of premature or full-term rupture of membranes should follow standard obstetric procedures; (x) Recommended infant antiretroviral prophylaxis has been updated; (xi) The duration of infant antiretroviral prophylaxis (gestational age ≥35 weeks and mother on effective ART and HIV RNA <200 copies/ml) has been changed from 4 to 2 weeks; (xii) Infants born to women with HIV RNA ≥200 copies/ml should receive 4 weeks of combination prophylaxis; (xiii) Fertility evaluation and assisted reproduction should be offered to women on suppressive ART according to the same principles as for other women; (xiv) Women living with HIV should still be advised against breastfeeding; (xv) Women who nevertheless opt to breastfeed should be offered intensified support and follow-up.
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Affiliation(s)
- Lars Navér
- Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Jan Albert
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Christina Carlander
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, University of Göteborg, Göteborg, Sweden
- Department of Infectious, Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Göteborg, Sweden
- Public Health Agency of Sweden, Solna, Sweden
| | - Kristina Pettersson
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Sandra Soeria-Atmadja
- Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Anders Sönnerborg
- Department of Clinical Virology, Karolinska University Hospital, Stockholm, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Westling
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Aylin Yilmaz
- Department of Infectious Diseases, University of Göteborg, Göteborg, Sweden
- Department of Infectious, Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Karin Pettersson
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Makonokaya L, Maida A, Kalitera LU, Wang A, Kapanda L, Kayira D, Bottoman M, Nkhoma H, Dunga S, Joaki Z, Chamanga R, Nkanaunena K, Hrapcak S, Nyirenda R, Chiwandira B, Maulidi M, Woelk G, Machekano R, Maphosa T. Early Effects of Scaling Up Dolutegravir-Based ARV Regimens Among Children Living with HIV in Malawi. AIDS Behav 2024:10.1007/s10461-024-04312-3. [PMID: 38615099 DOI: 10.1007/s10461-024-04312-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/15/2024]
Abstract
Viral suppression (VS) in children has remained suboptimal compared to that in adults. We evaluated the impact of transitioning children weighing < 20 kg to a pediatric formulation of dolutegravir (pDTG) on VS in Malawi. We analyzed routine retrospective program data from electronic medical record systems pooled across 169 healthcare facilities in Malawi supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). We included children who weighed < 20 kg and received antiretroviral therapy (ART) between July 2021-June 2022. Using descriptive statistics, we summarized demographic and clinical characteristics, ART regimens, ART adherence, and VS. We used logistic regression to identify factors associated with post-transition VS. A total of 2468 Children Living with HIV (CLHIV) were included, 55.3% of whom were < 60 months old. Most (83.8%) had initiated on non-DTG-based ART; 71.0% of these had a viral load (VL) test result before transitioning to pDTG, and 62.5% had VS. Nearly all (99.9%) CLHIV transitioned to pDTG-based regimens. Six months after the transition, 52.7% had good ART adherence, and 38.6% had routine VL testing results; 81.7% achieved VS. Post-transition VS was associated with good adherence and pre-transition VS: adjusted odds ratios of 2.79 (95% CI 1.65-4.71), p < 0.001 and 5.32 (95% CI 3.23-9.48), p < 0.001, respectively. After transitioning to pDTG, VS was achieved in most children tested within the first 6 months. However, adherence remained suboptimal post-transition and VL testing at 6 months was limited. Interventions to improve VL testing and enhance ART adherence are still needed in CLHIV on pDTG-based regimens.
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Affiliation(s)
| | - Alice Maida
- U. S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Lilongwe, Malawi
| | | | - Alice Wang
- U. S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Lilongwe, Malawi
| | - Lester Kapanda
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Dumbani Kayira
- U. S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Lilongwe, Malawi
| | | | - Harrid Nkhoma
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Shalom Dunga
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Zuze Joaki
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Rachel Chamanga
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Kondwani Nkanaunena
- U. S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Lilongwe, Malawi
| | - Susan Hrapcak
- U. S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Rose Nyirenda
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Brown Chiwandira
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Martin Maulidi
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Godfrey Woelk
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | | | - Thulani Maphosa
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
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3
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Mandelbrot L, Tubiana R, Frange P, Peytavin G, Le Chenadec J, Canestri A, Morlat P, Brunet-Cartier C, Sibiude J, Peretti D, Chambrin V, Chabrol A, Bui E, Simon-Toulza C, Marchand L, Paul C, Delmas S, Avettand-Fenoel V, Warszawski J. Maintenance darunavir/ritonavir monotherapy to prevent perinatal HIV transmission, ANRS-MIE 168 MONOGEST study. J Antimicrob Chemother 2023:7185847. [PMID: 37248782 DOI: 10.1093/jac/dkad161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES Because NRTIs can have fetal toxicities, we evaluated a perinatal NRTI-sparing strategy to prevent perinatal HIV transmission. Our primary objective was to determine the proportion maintaining a viral load (VL) of <50 copies/mL up to delivery on darunavir/ritonavir monotherapy, without requiring treatment intensification. METHODS In a one-arm, multicentre Phase 2 clinical trial, eligible patients in the first trimester of pregnancy on ART with plasma VL < 50 copies/mL received maintenance monotherapy with darunavir/ritonavir, 600/100 mg twice daily. VL was monitored monthly. ART was intensified in the case of VL > 50 copies/mL. Neonates received nevirapine prophylaxis for 14 days. RESULTS Of 89 patients switching to darunavir/ritonavir monotherapy, 4 miscarried before 22 weeks' gestation, 2 changed treatment for elevated liver enzymes without virological failure, and 83 were evaluable for the main outcome. Six had virological failure confirmed on a repeat sample (median VL = 193 copies/mL; range 78-644), including two before switching to monotherapy. In these six cases, ART was intensified with tenofovir disoproxil fumarate/emtricitabine. The success rate was 75/83, 90.4% (95% CI, 81.9%-95.7%) considering two patients with VL missing at delivery as failures, and 77/83, 92.8% (95% CI, 84.9%-97.3%) when considering them as successes since both had undetectable VL on darunavir/ritonavir throughout pregnancy. In ITT, the last available VL before delivery was <50 copies/mL in all of the patients. There was no case of perinatal HIV transmission. CONCLUSIONS Darunavir/ritonavir maintenance monotherapy required intensification in nearly 10% of cases. This limits its widespread use, thus other regimens should be evaluated in order to limit exposure to antiretrovirals, particularly NRTIs, during pregnancy.
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Affiliation(s)
- Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris Hôpital Louis Mourier Service de Gynécologie-Obstétrique, F-92700 Colombes, France
- Université Paris Cité, F-75006 Paris, France
- INSERM, IAME, F-75018 Paris, France
| | - Roland Tubiana
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Service Maladies infectieuses, F-75013 Paris, France
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Pierre Frange
- Université Paris Cité, F-75006 Paris, France
- Laboratoire de microbiologie clinique, Groupe hospitalier Assistance Publique-Hôpitaux de Paris (APHP) Centre-Université Paris Cité, Hôpital Necker-Enfants Malades, F-75015 Paris, France
| | - Gilles Peytavin
- INSERM, IAME, F-75018 Paris, France
- Assistance Publique-Hôpitaux de Paris, Laboratoire de Pharmaco-toxicologie, Hôpital Bichat, F-75018 Paris, France
| | | | - Ana Canestri
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de Maladies Infectieuses, F-75020 Paris, France
| | - Philippe Morlat
- Service de Médecine interne et Maladies infectieuses, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - Cécile Brunet-Cartier
- Service de Maladies infectieuses, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jeanne Sibiude
- Assistance Publique-Hôpitaux de Paris Hôpital Louis Mourier Service de Gynécologie-Obstétrique, F-92700 Colombes, France
- Université Paris Cité, F-75006 Paris, France
- INSERM, IAME, F-75018 Paris, France
| | - Delphine Peretti
- Assistance Publique-Hôpitaux de Paris, Hôpital Kremlin-Bicêtre, Service de Maladies Infectieuses, Le Kremlin-Bicêtre, France
| | - Véronique Chambrin
- Assistance Publique-Hôpitaux de Paris, Hôpital Antoine Béclère, Service de Maladies Infectieuses, Clamart, France
| | - Amélie Chabrol
- Centre Hospitalier du Sud Francilien, Service de Maladies Infectieuses, Evry, France
| | - Eida Bui
- Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Service de Maladies Infectieuses, F-75012 Paris, France
| | - Caroline Simon-Toulza
- Service de Médecine interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Lucie Marchand
- Agence Nationale de Recherches sur le sida et les hépatites virales ANRS|Maladies infectieuses émergentes, Paris, France
| | - Christelle Paul
- Agence Nationale de Recherches sur le sida et les hépatites virales ANRS|Maladies infectieuses émergentes, Paris, France
| | - Sandrine Delmas
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Institut National de la Santé et de la Recherche Médicale, SC10-US19, Villejuif, France
| | - Véronique Avettand-Fenoel
- Université Paris Cité, F-75006 Paris, France
- Laboratoire de microbiologie clinique, Groupe hospitalier Assistance Publique-Hôpitaux de Paris (APHP) Centre-Université Paris Cité, Hôpital Necker-Enfants Malades, F-75015 Paris, France
- INSERM U1016, CNRS, UMR8104, Institut Cochin, Paris, France
| | - Josiane Warszawski
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris, Epidemiology and Public Health Service, Service, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
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Sibiude J, Le Chenadec J, Mandelbrot L, Hoctin A, Dollfus C, Faye A, Bui E, Pannier E, Ghosn J, Garrait V, Avettand-Fenoel V, Frange P, Warszawski J, Tubiana R. Update of Perinatal Human Immunodeficiency Virus Type 1 Transmission in France: Zero Transmission for 5482 Mothers on Continuous Antiretroviral Therapy From Conception and With Undetectable Viral Load at Delivery. Clin Infect Dis 2023; 76:e590-e598. [PMID: 36037040 DOI: 10.1093/cid/ciac703] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/04/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) is remarkably effective in preventing perinatal transmission (PT) of HIV-1. We evaluated the PT rate in a population of women with widespread access to ART before conception. METHODS The analysis included 14 630 women with HIV-1 who delivered from 2000 to 2017 at centers participating in the nationwide prospective multicenter French Perinatal Cohort (ANRS-EPF). PT was analyzed according to time period, timing of ART initiation, maternal plasma viral load (pVL), and gestational age at birth. No infants were breastfed, and all received neonatal prophylaxis. RESULTS PT decreased between 3 periods, from 1.1% in 2000-2005 (58/5123) to 0.7% in 2006-2010 (30/4600) and to 0.2% in 2011-2017 (10/4907; P < .001). Restriction of the analysis to the 6316/14 630 (43%) women on ART at conception, PT decreased from 0.42% (6/1434) in 2000-2005 to 0.03% (1/3117) in 2011-2017 (P = .007). Among women treated at conception, if maternal pVL was undetectable near delivery, no PT was observed regardless of the ART combination [95%CI 0-0.07] (0/5482). Among women who started ART during pregnancy and with undetectable pVL near delivery, PT was 0.57% [95%CI 0.37-0.83] (26/4596). Among women treated at conception but with a detectable pVL near delivery, PT was 1.08% [95%CI 0.49-2.04] (9/834). We also qualitatively described 10 cases of transmission that occurred during the 2011-2017 period. CONCLUSIONS In a setting with free access to ART, monthly pVL assessment, infant ART prophylaxis, and in the absence of breastfeeding, suppressive ART initiated before pregnancy and continued throughout pregnancy can reduce PT of HIV to almost zero.
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Affiliation(s)
- Jeanne Sibiude
- Department of Gynecology-Obstetrics, Assistance Publique des Hôpitaux de Paris Hôpital Louis Mourier, Colombes, France.,Université de Paris, Infection, Antimicrobials, Modelling, Evolution UMR 1137, Institut national de la santé et de la recherche médicale, Paris, France
| | - Jérôme Le Chenadec
- Institut national de la santé et de la recherche médicale Centre d'Epidémiologie et de Santé des Populations U1018, Le Kremlin-Bicêtre, France
| | - Laurent Mandelbrot
- Université de Paris, Infection, Antimicrobials, Modelling, Evolution UMR 1137, Institut national de la santé et de la recherche médicale, Paris, France
| | - Alexandre Hoctin
- Institut national de la santé et de la recherche médicale Centre d'Epidémiologie et de Santé des Populations U1018, Le Kremlin-Bicêtre, France
| | - Catherine Dollfus
- Department of Pediatric Hematology-oncology, Assistance Publique des Hôpitaux de Paris Hôpital Trousseau, Paris, France
| | - Albert Faye
- Department of Pediatrics and Infectious Diseases, Assistance Publique des Hôpitaux de Paris Hôpital Robert Debré, Paris, France.,Université de Paris, Institut national de la santé et de la recherche médicale, U1123, Paris, France
| | - Eida Bui
- Department of Gynécology-Obstetrics, Assistance Publique des Hôpitaux de Paris Hôpital Trousseau, Paris, France
| | - Emmanuelle Pannier
- Department of Gynecology and Obstetrics, Assistance Publique des Hôpitaux de Paris, Maternité Port Royal, Paris, France
| | - Jade Ghosn
- Department of Infectious and Tropical Diseases, Assistance Publique des Hôpitaux de Paris, Nord, Hôpital Bichat - Claude Bernard, Paris, France
| | - Valerie Garrait
- Department of infectious diseases, Centre Hospitalier inter-communal de Créteil, Créteil, France
| | - Véronique Avettand-Fenoel
- Department of Clinical Microbiology, Assistance Publique des Hôpitaux de Paris Hôpital Necker-Enfants Malades, Université de Paris, Paris, France.,Institut national de la santé et de la recherche médicale U1016, Centre national de la recherche scientifique UMR8104, Institut Cochin, Paris, France
| | - Pierre Frange
- EHU 7328 PACT, Institut Imagine, Université de Paris, Paris, France
| | - Josiane Warszawski
- Department of Epidemiology and Public Health, Assistance Publique des Hôpitaux de Paris Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,Université Paris-Saclay, Institut national de la santé et de la recherche médicale Centre d'Epidémiologie et de Santé des Populations U1018, Le Kremlin-Bicêtre, France
| | - Roland Tubiana
- Department of Infectious and Tropical Diseases, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France.,Institut national de la santé et de la recherche médicale, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
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5
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Carvalho S, Lee T, Tulloch KJ, Sauve LJ, Samson L, Brophy JC, Bitnun A, Singer J, Money D, Kakkar F, Boucoiran I. Prescribing patterns of antiretroviral treatments during pregnancy for women living with HIV in Canada 2004-2020: A surveillance study. HIV Med 2023; 24:130-138. [PMID: 35699235 DOI: 10.1111/hiv.13346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND While treatment guidelines for HIV in adults have evolved rapidly with the advent of new antiretroviral (ARV) treatment, those for the prevention of vertical HIV transmission in pregnancy have evolved more slowly due to safety and efficacy concerns. Here we describe Canadian prescribing patterns for ARV treatments during pregnancy and compare them to perinatal HIV prescribing guidelines of the United States Department of Health and Human Services (HHS), that are commonly used in Canada and include recommendations for newly commercialized therapies. METHODS The Canadian Perinatal HIV Surveillance Program (CPHSP) captures annual medical data on mothers living with HIV and their infants from 23 sites across Canada. Women from this cohort who received an ARV treatment during pregnancy and who gave birth between 2004 and 2020 were included in the study. ARV treatments were designated as 'preferred/alternative' as per HHS HIV perinatal guidelines, or 'other than preferred/alternative'. RESULTS We identified 3673 pregnancies from 2720 women. The proportion of women that conceived while on ARV treatment increased from 29% in 2003 to 90% in 2020. Other than preferred/alternative ARV treatments were received in 1112 (30%) of pregnancies and this was significantly associated with having initiated ARV treatment before conception. CONCLUSION In Canada during the study period, a high number of women were prescribed an other than preferred/alternative ARV treatment during pregnancy. Further optimization of ARV treatment in women of childbearing age living with HIV is warranted.
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Affiliation(s)
- Sabrina Carvalho
- Faculty of Pharmacy, Université de Montréal, and Research Centre of the Saint-Justine University Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Terry Lee
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Karen J Tulloch
- Department of Pharmacy, British Columbia Women's Hospital and Health Centre and Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Laura J Sauve
- Department of Pediatrics, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindy Samson
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason C Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Ari Bitnun
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Joel Singer
- Department of Health Care and Epidemiology, University of British Columbia and CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Deborah Money
- Department of Obstetrics and Gynecology, British Columbia Women's Health Research Institute and Women's Hospital and Health Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fatima Kakkar
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Boucoiran
- School of Public Health, Université de Montréal, and Department of Obstetrics and Gynecology, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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6
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Ding L, Pannecouque C, De Clercq E, Zhuang C, Chen FE. Hydrophobic Pocket Occupation Design of Difluoro-Biphenyl-Diarylpyrimidines as Non-Nucleoside HIV-1 Reverse Transcriptase Inhibitors: from N-Alkylation to Methyl Hopping on the Pyrimidine Ring. J Med Chem 2021; 64:5067-5081. [PMID: 33851529 DOI: 10.1021/acs.jmedchem.1c00128] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Considering the nonideal metabolic stability of the difluoro-biphenyl-diarylpyrimidine lead compound 4, a series of novel alkylated difluoro-biphenyl-diarylpyrimidines were designed and synthesized based on their structure. Introducing alkyl or substituted alkyl groups on the linker region to block the potential metabolic sensitive sites generated 22 derivatives. Among them, compound 12a with an N-methyl group displayed excellent anti-HIV-1 activity and selectivity. The methyl group was hopped to the central pyrimidine to occupy the small linker region and maintain the water-mediated hydrogen bond observed in the binding of compound 4 with RT. The resulting compound 16y exhibited an improved anti-HIV-1 activity, much lower cytotoxicity, and nanomolar activity toward multiple mutants. In addition, 16y has a better stability in human liver microsomes than 4. Moreover, no apparent in vivo acute toxicity was observed in 16y-treated female, especially pregnant mice. This series of alkylated compounds with highly potency and safety represent a promising lead template for future discovery.
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Affiliation(s)
- Li Ding
- Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China.,Engineering Center of Catalysis and Synthesis for Chiral Molecules, Department of Chemistry, Fudan University, Shanghai 200433, China.,Shanghai Engineering Center of Industrial Asymmetric Catalysis for Chiral Drugs, Shanghai 200433, China
| | | | - Erik De Clercq
- Rega Institute for Medical Research, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Chunlin Zhuang
- Engineering Center of Catalysis and Synthesis for Chiral Molecules, Department of Chemistry, Fudan University, Shanghai 200433, China.,Shanghai Engineering Center of Industrial Asymmetric Catalysis for Chiral Drugs, Shanghai 200433, China
| | - Fen-Er Chen
- Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China.,Engineering Center of Catalysis and Synthesis for Chiral Molecules, Department of Chemistry, Fudan University, Shanghai 200433, China.,Shanghai Engineering Center of Industrial Asymmetric Catalysis for Chiral Drugs, Shanghai 200433, China.,Institute of Pharmaceutical Science and Technology, Zhejiang University of Technology, 18 Chao Wang Road, 310014 Hangzhou, China
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7
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Ding L, Zhuang C, Chen F. Druggability modification strategies of the diarylpyrimidine-type non-nucleoside reverse transcriptase inhibitors. Med Res Rev 2021; 41:1255-1290. [PMID: 33497504 DOI: 10.1002/med.21760] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/04/2020] [Accepted: 11/18/2020] [Indexed: 12/20/2022]
Abstract
Drug discovery of human immunodeficiency virus (HIV) is a hot field in medicinal chemistry community for many years. The diarylpyrimidines (DAPYs) are the second-generation non-nucleoside reverse transcriptase inhibitors (NNRTIs) targeting reverse transcriptase, playing a great irreplaceable role in HIV transcriptional therapy. However, fast-growing drug-resistant mutations as nonnegligible challenge are still unpredictably appeared in the clinical practice, leading to deactivate or reduce the existing drugs. In the last 20 years, more and more novel DAPY derivatives have developed with the purpose to counter the mutants. Nevertheless, most of them have dissatisfactory pharmacokinetics (PK) or poor antiviral activity toward resistant mutant strains. In this article, we will analyze the NNRTI derivatives with promising druggability, and summarize a series of druggability modification strategies to improve the antiviral activity, reduce toxicity and improve the PK properties in recent years. The prospects of DAPYs and the directions for future efforts will be discussed.
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Affiliation(s)
- Li Ding
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China.,Engineering Center of Catalysis and Synthesis for Chiral Molecules, Fudan University, Shanghai, China.,Shanghai Engineering Center of Industrial Asymmetric Catalysis for Chiral Drugs, Shanghai, China
| | - Chunlin Zhuang
- Engineering Center of Catalysis and Synthesis for Chiral Molecules, Fudan University, Shanghai, China.,Shanghai Engineering Center of Industrial Asymmetric Catalysis for Chiral Drugs, Shanghai, China
| | - Fener Chen
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China.,Engineering Center of Catalysis and Synthesis for Chiral Molecules, Fudan University, Shanghai, China.,Shanghai Engineering Center of Industrial Asymmetric Catalysis for Chiral Drugs, Shanghai, China.,Institute of Pharmaceutical Science and Technology, Zhejiang University of Technology, Hangzhou, China
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