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Fisher SA, Madden N, Espinal M, Garcia PM, Jao JK, Yee LM. Clinical Trials That Have Changed Clinical Practice and Care of Pregnant People With HIV. Clin Obstet Gynecol 2024; 67:381-398. [PMID: 38450526 DOI: 10.1097/grf.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Over the last 4 decades, significant advances in the care of HIV during pregnancy have successfully reduced, and nearly eliminated, the risk of perinatal HIV transmission. The baseline risk of transmission without intervention (25% to 30%) is now <1% to 2% in the United States with contemporary antepartum, intrapartum, and postnatal interventions. In this review, we discuss 3 landmark clinical trials that substantially altered obstetric practice for pregnant individuals with HIV and contributed to this extraordinary achievement: 1) the Pediatric AIDS Clinical Trials Group 076 Trial determined that antepartum and intrapartum administration of antiretroviral drug zidovudine to the pregnant individual, and postnatally to the newborn, could reduce the risk of perinatal transmission by approximately two-thirds; 2) the European Mode of Delivery Collaboration Trial demonstrated performance of a prelabor cesarean birth before rupture of membranes among pregnant people with viremia reduced the risk of perinatal transmission compared with vaginal birth; and 3) the International Maternal Pediatric Adolescent AIDS Clinical Trials Network 2010 Trial identified that dolutegravir-containing, compared with efavirenz-containing, antiretroviral regimens during pregnancy achieved a significantly higher rate of viral suppression at delivery with shorter time to viral suppression, with fewer adverse pregnancy outcomes. Collectively, these trials not only advanced obstetric practice but also advanced scientific understanding of the timing, mechanisms, and determinants of perinatal HIV transmission. For each trial, we will describe key aspects of the study protocol and outcomes, insights gleaned about the dynamics of perinatal transmission, how each study changed clinical practice, and relevant updates to current practice since the trial's publication.
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Affiliation(s)
- Stephanie A Fisher
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology
| | - Nigel Madden
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology
| | - Mariana Espinal
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology
| | - Patricia M Garcia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology
| | - Jennifer K Jao
- Division of Infectious Diseases, Departments of Medicine and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology
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Wiseman RL, Bigos KL, Dastgheyb RM, Barker PB, Rubin LH, Slusher BS. Brain N -acetyl-aspartyl-glutamate is associated with cognitive function in older virally suppressed people with HIV. AIDS 2024; 38:1003-1011. [PMID: 38411600 PMCID: PMC11062820 DOI: 10.1097/qad.0000000000003871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/05/2024] [Accepted: 02/14/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVES Cognitive impairment persists in virally suppressed people with HIV (VS-PWH) especially in higher order domains. One cortical circuit, linked to these domains, is regulated by N -acetyl-aspartyl glutamate (NAAG), the endogenous agonist of the metabotropic glutamate receptor 3. The enzyme glutamate carboxypeptidase II (GCPII) catabolizes NAAG and is upregulated in aging and disease. Inhibition of GCPII increases brain NAAG and improves learning and memory in rodent and primate models. DESIGN As higher order cognitive impairment is present in VS-PWH, and NAAG has not been investigated in earlier magnetic resonance spectroscopy studies (MRS), we investigated if brain NAAG levels measured by MRS were associated with cognitive function. METHODS We conducted a retrospective analysis of 7-Tesla MRS data from a previously published study on cognition in older VS-PWH. The original study did not separately quantify NAAG, therefore, work for this report focused on relationships between regional NAAG levels in frontal white matter (FWM), left hippocampus, left basal ganglia and domain-specific cognitive performance in 40 VS-PWH after adjusting for confounds. Participants were older than 50 years, negative for affective and neurologic disorders, and had no prior 3-month psychoactive-substance use. RESULTS Higher NAAG levels in FWM were associated with better attention/working memory. Higher left basal ganglia NAAG related to better verbal fluency. There was a positive relationship between hippocampal NAAG and executive function which lost significance after correction for confounds. CONCLUSION These data suggest brain NAAG serves as a biomarker of cognition in VS-PWH. Pharmacological modulation of brain NAAG warrants investigation as a therapeutic approach for cognitive deficits in VS-PWH.
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Affiliation(s)
- Robyn L. Wiseman
- Department of Pharmacology and Molecular Sciences
- Johns Hopkins Drug Discovery
- Department of Medicine, Division of Clinical Pharmacology
| | - Kristin L. Bigos
- Department of Pharmacology and Molecular Sciences
- Department of Medicine, Division of Clinical Pharmacology
- Department of Psychiatry and Behavioral Sciences
| | | | - Peter B. Barker
- Russell H. Morgan Department of Radiology and Radiological Sciences
| | - Leah H. Rubin
- Department of Psychiatry and Behavioral Sciences
- Department of Neurology
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Barbara S. Slusher
- Department of Pharmacology and Molecular Sciences
- Johns Hopkins Drug Discovery
- Department of Medicine, Division of Clinical Pharmacology
- Department of Psychiatry and Behavioral Sciences
- Department of Neurology
- Department of Oncology
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Prince MA, Tan MC, Tan MX, George H, Prince EO, Nicholas RM, Shaaban H, Slim J. Exploring the impact of therapeutic advances in HIV-related mortality in the United States. IJID REGIONS 2024; 11:100347. [PMID: 38584850 PMCID: PMC10997884 DOI: 10.1016/j.ijregi.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024]
Abstract
Objectives Mortality from HIV has significantly declined with the introduction of highly active antiretroviral therapy (HAART). This study sought to examine the longitudinal trends in mortality from HIV-related diseases by race, sex, geographical region, and over time as HAART trends changed. Methods We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database and performed serial cross-sectional analyses of national death certificate data for all-cause mortality with comorbid HIV from 1999 to 2020. HIV diseases (International Classification of Diseases, Tenth Revision codes B20-B24, O98.7, R75) were listed as the contributing cause of death. We calculated the age-adjusted mortality ratio (AAMR) per 1,000,000 individuals and determined mortality trends using the Joinpoint Regression Program. Subgroup analyses were performed by sex, race, region, and organ system. The study period was further stratified into three groups when specific drug regimens were more prevalent. Results In the 22-year study period, 251,759 all-cause mortalities with comorbid HIV were identified. The leading cause of death was infectious disease (84.0%, N = 211,438). Men recorded a higher AAMR than women (4.66 vs 1.65, P < 0.01). African American individuals had the highest AAMR (13.46) compared to White, American Indian, and Asian individuals (1.70 vs 1.65 vs 0.47). The South region had the highest AAMR (4.32) and urban areas had a higher AAMR compared to rural areas (1.77 vs 0.88). Conclusions More than 80% of deaths occurred because of infectious disease over the last 2 decades with a decreasing trend over time when stratified by race, sex, and geographical region. Despite advances in HAART, mortality disparities persist which emphasizes the need for targeted interventions in these populations.
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Affiliation(s)
- Monique A Prince
- Department of Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | - Min-Choon Tan
- Department of Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | | | | | | | | | - Hamid Shaaban
- Department of Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | - Jihad Slim
- Department of Internal Medicine, Saint Michael's Medical Center, Newark, USA
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Chen X, Chen X, Lai Y. Development and emerging trends of drug resistance mutations in HIV: a bibliometric analysis based on CiteSpace. Front Microbiol 2024; 15:1374582. [PMID: 38812690 PMCID: PMC11133539 DOI: 10.3389/fmicb.2024.1374582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/06/2024] [Indexed: 05/31/2024] Open
Abstract
Background Antiretroviral therapy has led to AIDS being a chronic disease. Nevertheless, the presence of constantly emerging drug resistance mutations poses a challenge to clinical treatment. A systematic analysis to summarize the advancements and uncharted territory of drug resistance mutations is urgently needed and may provide new clues for solving this problem. Methods We gathered 3,694 publications on drug resistance mutations from the Web of Science Core Collection with CiteSpace software and performed an analysis to visualize the results and predict future new directions and emerging trends. Betweenness centrality, count, and burst value were taken as standards. Results The number of papers on HIV medication resistance mutations during the last 10 years shows a wave-like trend. In terms of nation, organization, and author, the United States (1449), University of London (193), and Mark A. Wainberg (66) are the most significant contributors. The most frequently cited article is "Drug resistance mutations for surveillance of transmitted HIV-1 drug-resistance: 2009 update." Hot topics in this field include "next-generation sequencing," "tenofovir alafenamide," "children," "regimens," "accumulation," "dolutegravir," "rilpivirine," "sex," "pretreatment drug resistance," and "open label." Research on drug resistance in teenagers, novel mutation detection techniques, and drug development is ongoing, and numerous publications have indicated the presence of mutations related to current medications. Therefore, testing must be performed regularly for patients who have used medications for a long period. Additionally, by choosing medications with a longer half-life, patients can take fewer doses of their prescription, increasing patient compliance. Conclusion This study involved a bibliometric visualization analysis of the literature on drug resistance mutations, providing insight into the field's evolution and emerging patterns and offering academics a resource to better understand HIV drug resistance mutations and contribute to the field's advancement.
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Affiliation(s)
- Xuannan Chen
- Acupunture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xi Chen
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu Lai
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Sun M, Manson ML, Guo T, de Lange ECM. CNS Viral Infections-What to Consider for Improving Drug Treatment: A Plea for Using Mathematical Modeling Approaches. CNS Drugs 2024; 38:349-373. [PMID: 38580795 PMCID: PMC11026214 DOI: 10.1007/s40263-024-01082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/07/2024]
Abstract
Neurotropic viruses may cause meningitis, myelitis, encephalitis, or meningoencephalitis. These inflammatory conditions of the central nervous system (CNS) may have serious and devastating consequences if not treated adequately. In this review, we first summarize how neurotropic viruses can enter the CNS by (1) crossing the blood-brain barrier or blood-cerebrospinal fluid barrier; (2) invading the nose via the olfactory route; or (3) invading the peripheral nervous system. Neurotropic viruses may then enter the intracellular space of brain cells via endocytosis and/or membrane fusion. Antiviral drugs are currently used for different viral CNS infections, even though their use and dosing regimens within the CNS, with the exception of acyclovir, are minimally supported by clinical evidence. We therefore provide considerations to optimize drug treatment(s) for these neurotropic viruses. Antiviral drugs should cross the blood-brain barrier/blood cerebrospinal fluid barrier and pass the brain cellular membrane to inhibit these viruses inside the brain cells. Some antiviral drugs may also require intracellular conversion into their active metabolite(s). This illustrates the need to better understand these mechanisms because these processes dictate drug exposure within the CNS that ultimately determine the success of antiviral drugs for CNS infections. Finally, we discuss mathematical model-based approaches for optimizing antiviral treatments. Thereby emphasizing the potential of CNS physiologically based pharmacokinetic models because direct measurement of brain intracellular exposure in living humans faces ethical restrictions. Existing physiologically based pharmacokinetic models combined with in vitro pharmacokinetic/pharmacodynamic information can be used to predict drug exposure and evaluate efficacy of antiviral drugs within the CNS, to ultimately optimize the treatments of CNS viral infections.
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Affiliation(s)
- Ming Sun
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Martijn L Manson
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Tingjie Guo
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Elizabeth C M de Lange
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands.
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Navasardyan I, Miwalian R, Petrosyan A, Yeganyan S, Venketaraman V. HIV-TB Coinfection: Current Therapeutic Approaches and Drug Interactions. Viruses 2024; 16:321. [PMID: 38543687 PMCID: PMC10974211 DOI: 10.3390/v16030321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 05/23/2024] Open
Abstract
The co-occurrence of human immunodeficiency virus (HIV) and tuberculosis (TB) infection poses a significant global health challenge. Treatment of HIV and TB co-infection often necessitates combination therapy involving antiretroviral therapy (ART) for HIV and anti-TB medications, which introduces the potential for drug-drug interactions (DDIs). These interactions can significantly impact treatment outcomes, the efficacy of treatment, safety, and overall patient well-being. This review aims to provide a comprehensive analysis of the DDIs between anti-HIV and anti-TB drugs as well as potential adverse effects resulting from the concomitant use of these medications. Furthermore, such findings may be used to develop personalized therapeutic strategies, dose adjustments, or alternative drug choices to minimize the risk of adverse outcomes and ensure the effective management of HIV and TB co-infection.
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Affiliation(s)
| | | | | | | | - Vishwanath Venketaraman
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA; (I.N.); (R.M.); (A.P.); (S.Y.)
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Borjabad B, Inciarte A, Chivite I, Gonzalez-Cordon A, Mosquera M, Hurtado C, Rovira C, Gonzalez T, Sempere A, Torres B, Calvo J, De La Mora L, Martinez-Rebollar M, Laguno M, Foncillas A, Ambrosioni J, Blanch J, Rodriguez A, Solbes E, Llobet R, Berrocal L, Mallolas J, Miro JM, Alcami J, Blanco JL, Sanchez-Palomino S, De Lazzari E, Martinez E. Efficacy and safety of raltegravir plus lamivudine maintenance therapy. J Antimicrob Chemother 2024; 79:255-261. [PMID: 38039097 DOI: 10.1093/jac/dkad364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Decreasing medication burden with raltegravir plus lamivudine in virologically suppressed persons with HIV (PWH) maintained efficacy and was well tolerated at 24 weeks, but more comprehensive data over longer follow-up are required. METHODS Prospective 48 week extension phase of the raltegravir plus lamivudine arm from a previous 24 week pilot randomized clinical trial in which virologically suppressed PWH were randomized 2:1 to switch to fixed-dose combination 150 mg lamivudine/300 mg raltegravir twice daily or to continue therapy. In this 48 week extension phase, raltegravir was dosed at 1200 mg/day and lamivudine 300 mg/day. Primary outcome was the proportion of PWH with treatment failure at Week 48. Secondary outcomes were changes in ultrasensitive plasma HIV RNA, HIV DNA in CD4 cells, serum IL-6, ultrasensitive C-reactive protein and sCD14, body composition, sleep quality, quality of life and adverse effects. RESULTS Between May 2018 and June 2019, 33 PWH were enrolled. One participant experienced virological failure without resistance mutations and re-achieved sustained virological suppression without therapy discontinuation, and two others discontinued therapy due to adverse effects. Treatment failure was 9% (95% CI 2%-24%) and 3% (95% CI 0%-17%) in the ITT and on-treatment populations. There were significant changes between baseline and Week 48 in serum cytokines but not in other secondary outcomes. CONCLUSIONS Switching to raltegravir and lamivudine in PWH with virological suppression maintains efficacy and is well tolerated. This maintenance regimen might be a cost-effective option for PWH at risk of drug-drug interactions or needing to avoid specific toxicities of certain antiretroviral drugs or their negative impact on comorbidities.
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Affiliation(s)
- Beatriz Borjabad
- Internal Medicine Service, Hospital Moises Broggi, Sant Joan Despí, Spain
| | - Alexy Inciarte
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Ivan Chivite
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Ana Gonzalez-Cordon
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Mar Mosquera
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Hurtado
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Cristina Rovira
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Tania Gonzalez
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Abiu Sempere
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Berta Torres
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Julia Calvo
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Lorena De La Mora
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Martinez-Rebollar
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Laguno
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Alberto Foncillas
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Juan Ambrosioni
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Blanch
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- Internal Medicine Service, Hospital Universitari de Santa Maria, Lleida, Spain
- CIBER de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Rodriguez
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Estela Solbes
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Roger Llobet
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Leire Berrocal
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
| | - Josep Mallolas
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose M Miro
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose Alcami
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Acquired Immunodeficiency Syndrome (AIDS) Immunopathology Unit, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Spain
| | - Jose L Blanco
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Sonsoles Sanchez-Palomino
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisa De Lazzari
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Esteban Martinez
- Infectious Diseases Unit, Hospital Clínic, University of Barcelona 08036, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Branda F, Giovanetti M, Sernicola L, Farcomeni S, Ciccozzi M, Borsetti A. Comprehensive Analysis of HIV-1 Integrase Resistance-Related Mutations in African Countries. Pathogens 2024; 13:102. [PMID: 38392840 PMCID: PMC10892843 DOI: 10.3390/pathogens13020102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
The growing emergence of non-nucleoside reverse transcriptase inhibitor (NNRTI) HIV drug resistance in sub-Saharan Africa (SSA) led to the World Health Organization (WHO) recommending, in 2018, a transition to dolutegravir (DTG) as a first-line antiretroviral therapy (ART) in SSA. The broad HIV-1 genetic diversity in SSA could shape DTG effectiveness and the pattern of drug resistance mutations (DRMs) in this region. This study evaluated HIV-1 integrase (IN) DRMs and conserved regions among published groups M, N, O, and P HIV-1 sequences spanning forty years of the HIV epidemic during the transition of DTG-based ART. Overall, we found low levels of integrase strand transfer inhibitor (INSTI)-DRMs (<1%) across HIV groups between the years 1983 and 2023; however, it was unexpected to detect DRMs at statistically significantly higher frequencies in pre-INSTI (1983-2007) than in the INSTI (2008-2023) era. The variability of accessory INSTI-DRMs depended on the HIV subtypes, with implications for susceptibility to DTG. Our findings provide new perspectives on the molecular epidemiology and drug resistance profiles of INSTIs in SSA, emphasizing the need for ongoing surveillance and customized treatment approaches to address the continent's varied HIV subtypes and changing resistance patterns.
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Affiliation(s)
- Francesco Branda
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, 00128 Rome, Italy; (F.B.); (M.C.)
| | - Marta Giovanetti
- Sciences and Technologies for Sustainable Development and One Health, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Belo Horizonte 30190-002, Brazil
- Climate Amplified Diseases and Epidemics (CLIMADE), Brasilia 70070-130, Brazil
| | - Leonardo Sernicola
- National HIV/AIDS Research Center (CNAIDS), Istituto Superiore di Sanità, 00161 Rome, Italy; (L.S.); (S.F.)
| | - Stefania Farcomeni
- National HIV/AIDS Research Center (CNAIDS), Istituto Superiore di Sanità, 00161 Rome, Italy; (L.S.); (S.F.)
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, 00128 Rome, Italy; (F.B.); (M.C.)
| | - Alessandra Borsetti
- National HIV/AIDS Research Center (CNAIDS), Istituto Superiore di Sanità, 00161 Rome, Italy; (L.S.); (S.F.)
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Chandiwana NC, Siedner MJ, Marconi VC, Hill A, Ali MK, Batterham RL, Venter WDF. Weight Gain After HIV Therapy Initiation: Pathophysiology and Implications. J Clin Endocrinol Metab 2024; 109:e478-e487. [PMID: 37437159 PMCID: PMC10795932 DOI: 10.1210/clinem/dgad411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 06/14/2023] [Accepted: 07/10/2023] [Indexed: 07/14/2023]
Abstract
Rapid advances in the potency, safety, and availability of modern HIV antiretroviral therapy (ART) have yielded a near-normal life expectancy for most people living with HIV (PLWH). Ironically, considering the history of HIV/AIDS (initially called "slim disease" because of associated weight loss), the latest dilemma faced by many people starting HIV therapy is weight gain and obesity, particularly Black people, women, and those who commenced treatment with advanced immunodeficiency. We review the pathophysiology and implications of weight gain among PLWH on ART and discuss why this phenomenon was recognized only recently, despite the availability of effective therapy for nearly 30 years. We comprehensively explore the theories of the causes, from initial speculation that weight gain was simply a return to health for people recovering from wasting to comparative effects of newer regimens vs prior toxic agents, to direct effects of agents on mitochondrial function. We then discuss the implications of weight gain on modern ART, particularly concomitant effects on lipids, glucose metabolism, and inflammatory markers. Finally, we discuss intervention options for PLWH and obesity, from the limitations of switching ART regimens or specific agents within regimens, weight-gain mitigation strategies, and potential hope in access to emerging antiobesity agents, which are yet to be evaluated in this population.
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Affiliation(s)
- Nomathemba C Chandiwana
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Mark J Siedner
- Medical Practice Evaluation Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Vincent C Marconi
- Division of Infectious Diseases and Department of Global Health, Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA 4223, USA
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool L69 7BE, UK
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 4223, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | | | - Willem Daniel Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
- Department of Public Health Medicine, Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria 0028, South Africa
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Attaianese F, Dalpiaz I, Failla M, Pasquali E, Galli L, Chiappini E. Fixed-dose antiretroviral combinations in children living with human immunodeficiency virus type 1 (HIV-1): a systematic review. J Chemother 2023:1-15. [PMID: 38153234 DOI: 10.1080/1120009x.2023.2297095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/12/2023] [Indexed: 12/29/2023]
Abstract
Fixed-Dose antiretroviral Combinations (FDCs) are the most used drug regimes in adult patients with human-immunodeficiency virus 1 infection, since they increase adherence to antiretroviral therapy and enable good quality of life. The European AIDS Clinical Society guidelines recommend the use of FDCs in paediatrics. However, the use of FDCs in paediatric population is restricted since studies in children and adolescents are mostly conducted in small sample sizes and are heterogeneous in settings and design. This systematic review aims to summarize the current knowledge about the use of FDCs in paediatric population, highlighting the relevant outcomes regarding efficacy and effectiveness, adherence, safety, and adverse events of these regimens.
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Affiliation(s)
- Federica Attaianese
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
| | - Irene Dalpiaz
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
| | - Martina Failla
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
| | - Elisa Pasquali
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
- Paediatric Infectious Disease Unit, IRCCS Anna Meyer Children's Hospital, Florence, Italy
| | - Elena Chiappini
- Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy
- Paediatric Infectious Disease Unit, IRCCS Anna Meyer Children's Hospital, Florence, Italy
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11
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Kanise H, van Oosterhout JJ, Bisani P, Songo J, Matola BW, Chipungu C, Simon K, Cox C, Hosseinipour MC, Sagno JB, Hoffman RM, Wallrauch C, Phiri S, Steegen K, Jahn A, Nyirenda R, Heller T. Virological Findings and Treatment Outcomes of Cases That Developed Dolutegravir Resistance in Malawi's National HIV Treatment Program. Viruses 2023; 16:29. [PMID: 38257730 PMCID: PMC10819735 DOI: 10.3390/v16010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/28/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Millions of Africans are on dolutegravir-based antiretroviral therapy (ART), but few detailed descriptions of dolutegravir resistance and its clinical management exist. We reviewed HIV drug resistance (HIVDR) testing application forms submitted between June 2019 and October 2022, data from the national HIVDR database, and genotypic test results. We obtained standardized ART outcomes and virological results of cases with dolutegravir resistance, and explored associations with dolutegravir resistance among individuals with successful integrase sequencing. All cases were on two nucleoside reverse transcriptase inhibitors (NRTIs)/dolutegravir, and had confirmed virological failure, generally with prolonged viremia. Among 89 samples with successful integrase sequencing, 24 showed dolutegravir resistance. Dolutegravir resistance-associated mutations included R263K (16/24), E138K (7/24), and G118R (6/24). In multivariable logistic regression analysis, older age and the presence of high-level NRTI resistance were significantly associated with dolutegravir resistance. After treatment modification recommendations, four individuals (17%) with dolutegravir resistance died, one self-discontinued ART, one defaulted, and one transferred out. Of the 17 remaining individuals, 12 had follow-up VL results, and 11 (92%) were <1000 copies/mL. Twenty-four cases with dolutegravir resistance among 89 individuals with confirmed virological failure suggests a considerable prevalence in the Malawi HIV program. Successful management of dolutegravir resistance was possible, but early mortality was high. More research on the management of treatment-experienced individuals with dolutegravir resistance is needed.
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Affiliation(s)
- Hope Kanise
- Partners in Hope, Lilongwe P.O. Box 302, Malawi; (H.K.); (J.S.); (C.C.); (S.P.)
| | - Joep J. van Oosterhout
- Partners in Hope, Lilongwe P.O. Box 302, Malawi; (H.K.); (J.S.); (C.C.); (S.P.)
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
| | - Pachawo Bisani
- The Lighthouse Trust, Lilongwe P.O. Box 106, Malawi; (P.B.); (C.W.); (T.H.)
| | - John Songo
- Partners in Hope, Lilongwe P.O. Box 302, Malawi; (H.K.); (J.S.); (C.C.); (S.P.)
| | - Bilaal W. Matola
- Directorate of HIV, STI and Viral Hepatitis, Ministry of Health, Lilongwe P.O. Box 30377, Malawi; (B.W.M.); (A.J.); (R.N.)
| | - Chifundo Chipungu
- Partners in Hope, Lilongwe P.O. Box 302, Malawi; (H.K.); (J.S.); (C.C.); (S.P.)
| | - Katherine Simon
- Baylor College of Medicine Children’s Foundation-Malawi, Lilongwe P.O. Box 110, Malawi; (K.S.); (C.C.)
- Baylor College of Medicine, Houston, TX 77030, USA
| | - Carrie Cox
- Baylor College of Medicine Children’s Foundation-Malawi, Lilongwe P.O. Box 110, Malawi; (K.S.); (C.C.)
- Baylor College of Medicine, Houston, TX 77030, USA
| | - Mina C. Hosseinipour
- University of North Carolina Project Malawi, Lilongwe Private Bag A-104, Malawi;
- Department of Medicine, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC 27599, USA
| | | | - Risa M. Hoffman
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
| | - Claudia Wallrauch
- The Lighthouse Trust, Lilongwe P.O. Box 106, Malawi; (P.B.); (C.W.); (T.H.)
| | - Sam Phiri
- Partners in Hope, Lilongwe P.O. Box 302, Malawi; (H.K.); (J.S.); (C.C.); (S.P.)
- School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe P.O. Box 30184, Malawi
| | - Kim Steegen
- Department of Haematology & Molecular Medicine, National Health Laboratory Service, Johannesburg 2131, South Africa;
- Department of Haematology & Molecular Medicine, University of the Witwatersrand, Johannesburg 2017, South Africa
| | - Andreas Jahn
- Directorate of HIV, STI and Viral Hepatitis, Ministry of Health, Lilongwe P.O. Box 30377, Malawi; (B.W.M.); (A.J.); (R.N.)
- Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Rose Nyirenda
- Directorate of HIV, STI and Viral Hepatitis, Ministry of Health, Lilongwe P.O. Box 30377, Malawi; (B.W.M.); (A.J.); (R.N.)
| | - Tom Heller
- The Lighthouse Trust, Lilongwe P.O. Box 106, Malawi; (P.B.); (C.W.); (T.H.)
- International Training and Education Center for Health (ITECH), University of Washington, Seattle, WA 98104-2499, USA
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12
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Romanelli MN, Braconi L, Gabellini A, Manetti D, Marotta G, Teodori E. Synthetic Approaches to Piperazine-Containing Drugs Approved by FDA in the Period of 2011-2023. Molecules 2023; 29:68. [PMID: 38202651 PMCID: PMC10780301 DOI: 10.3390/molecules29010068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
The piperazine moiety is often found in drugs or in bioactive molecules. This widespread presence is due to different possible roles depending on the position in the molecule and on the therapeutic class, but it also depends on the chemical reactivity of piperazine-based synthons, which facilitate its insertion into the molecule. In this paper, we take into consideration the piperazine-containing drugs approved by the Food and Drug Administration between January 2011 and June 2023, and the synthetic methodologies used to prepare the compounds in the discovery and process chemistry are reviewed.
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Affiliation(s)
- Maria Novella Romanelli
- Section of Pharmaceutical and Nutraceutical Science, Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Via Ugo Schiff, 6, Sesto Fiorentino, 50019 Florence, Italy; (L.B.); (A.G.); (D.M.); (G.M.); (E.T.)
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13
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Wagner T, Levy I, Elbirt D, Shahar E, Olshtain-Pops K, Elinav H, Chowers M, Istomin V, Riesenberg K, Geva D, Zuckerman NS, Wax M, Shirazi R, Gozlan Y, Matus N, Girshengorn S, Marom R, Mendelson E, Mor O, Turner D. Factors Associated with Virological Failure in First-Line Antiretroviral Therapy in Patients Diagnosed with HIV-1 between 2010 and 2018 in Israel. Viruses 2023; 15:2439. [PMID: 38140680 PMCID: PMC10748212 DOI: 10.3390/v15122439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Despite the progress in contemporary antiretroviral therapy (ART) and the continuous changes in treatment guidelines, virological failure (VF) is still an ongoing concern. The goal of this study was to assess factors related to VF after first-line ART. A longitudinal cohort retrospective study of individuals on first-line ART diagnosed with HIV-1 in 2010-2018 and followed-up for a median of two years was conducted. Demographics, baseline and longitudinal CD4 counts, treatment regimens, adherence and VF were recorded. The Cox proportional hazards regression and mixed models were used. A cohort of 1130 patients were included. Overall, 80% were males and 62% were Israeli-born individuals. Compared to individuals diagnosed in 2010-2014, when treatment was initiated according to CD4 levels, those diagnosed in 2015-2018 were older and had lower baseline CD4 counts. VF was recorded in 66 (5.8%) patients. Diagnosis with CD4 <200 cells/mmᶟ with AIDS-defining conditions (HR = 2.75, 95%CI:1.52-4.97, p < 0.001) and non-integrase strand transfer inhibitor regimens (non-INSTI, HR = 1.80, 95%CI:1.01-3.24, p = 0.047) increased VF risk. No impact of baseline resistance was observed. We concluded that the early detection of HIV-1 infection and usage of INSTI-based regimens are recommended to reduce VF.
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Affiliation(s)
- Tali Wagner
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Itzchak Levy
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- Infectious Disease Unit, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Daniel Elbirt
- Faculty of Medicine, Hadassah Braun School of Public Health & Community Medicine, The Hebrew University, Jerusalem 9112102, Israel
- Immunology, Kaplan Medical Center, Rehovot 76100, Israel
| | - Eduardo Shahar
- Immunology Unit, Rambam Health Care Campus, Haifa 3109601, Israel
- Rappaport Faculty of Medicine, Institute of Technology, Technion, Haifa 3109601, Israel
| | | | - Hila Elinav
- Faculty of Medicine, Hadassah Braun School of Public Health & Community Medicine, The Hebrew University, Jerusalem 9112102, Israel
- Hadassah Medical Center, Jerusalem 9112102, Israel
| | - Michal Chowers
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- Infectious Diseases, Meir Medical Center, Kfar Saba 4428164, Israel
| | | | - Klaris Riesenberg
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 8410501, Israel
- Infectious Disease Institute, Soroka Medical Center, Beersheba 84101, Israel
| | - Dikla Geva
- Integristat Ltd., Tel Aviv 69051, Israel
| | - Neta S Zuckerman
- National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Marina Wax
- National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Rachel Shirazi
- National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Yael Gozlan
- National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Natasha Matus
- Ichilov Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel
| | - Shirley Girshengorn
- Ichilov Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel
| | - Rotem Marom
- Ichilov Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel
| | - Ella Mendelson
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Orna Mor
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Dan Turner
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- Ichilov Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel
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14
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Loaiza JD, Chvatal-Medina M, Hernandez JC, Rugeles MT. Integrase inhibitors: current protagonists in antiretroviral therapy. Immunotherapy 2023; 15:1477-1495. [PMID: 37822251 DOI: 10.2217/imt-2023-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Since HIV was identified as the etiological agent of AIDS, there have been significant advances in antiretroviral therapy (ART) that has reduced morbidity/mortality. Still, the viral genome's high mutation rate, suboptimal ART regimens, incomplete adherence to therapy and poor control of the viral load generate variants resistant to multiple drugs. Licensing over 30 anti-HIV drugs worldwide, including integrase inhibitors, has marked a milestone since they are potent and well-tolerated drugs. In addition, they favor a faster recovery of CD4+ T cells. They also increase the diversity profile of the gut microbiota and reduce inflammatory markers. All of these highlight the importance of including them in different ART regimens.
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Affiliation(s)
- John D Loaiza
- Grupo Inmunovirología, Facultad de medicina, Universidad de Antioquia, Medellín, 050010, Colombia
| | - Mateo Chvatal-Medina
- Grupo Inmunovirología, Facultad de medicina, Universidad de Antioquia, Medellín, 050010, Colombia
| | - Juan C Hernandez
- Infettare, Facultad de medicina, Universidad Cooperativa de Colombia, Medellín, 050012, Colombia
| | - Maria T Rugeles
- Grupo Inmunovirología, Facultad de medicina, Universidad de Antioquia, Medellín, 050010, Colombia
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15
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De Clercq E, Zhang Z, Huang J, Zhang M, Li G. Biktarvy for the treatment of HIV infection: Progress and prospects. Biochem Pharmacol 2023; 217:115862. [PMID: 37858869 DOI: 10.1016/j.bcp.2023.115862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
Bictegravir (BIC), a second-generation integrase strand-transfer inhibitor (INSTI) with high resilience to INSTI-resistance mutations, is integrated as a key component of Biktarvy® - a fixed-dose once-daily triple-drug regimen of bictegravir (BIC), emtricitabine (FTC) plus tenofovir alafenamide (TAF). Based on the accumulated evidence from HIV clinical trials and real-world studies, the clinical effectiveness of BIC + FTC + TAF has been proven non-inferior to other fixed-dose once-daily combinations such as dolutegravir + FTC + TAF and dolutegravir + abacavir + lamivudine. Biktarvy also shows limited drug-drug interactions and a high barrier to drug resistance. According to recent HIV guidelines, BIC + FTC + TAF is recommended as initial and long-term therapy for the treatment of HIV infection. For the pre-exposure prophylaxis, tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF) remains advisable, but BIC may be possibly added to TDF or TAF. In the development of a long-acting once-monthly regimen, the novel nano-formulation of BIC + FTC + TAF could be possibly developed in the future.
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Affiliation(s)
- Erik De Clercq
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven 3000, Belgium
| | - Zhenlan Zhang
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha 410013, China
| | - Jie Huang
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha 410013, China
| | - Min Zhang
- Institute of Hepatology and Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha 410011, China.
| | - Guangdi Li
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha 410013, China; FuRong Laboratory, Changsha 410078, China.
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16
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Amariles P, Rivera-Cadavid M, Ceballos M. Clinical Relevance of Drug Interactions in People Living with Human Immunodeficiency Virus on Antiretroviral Therapy-Update 2022: Systematic Review. Pharmaceutics 2023; 15:2488. [PMID: 37896248 PMCID: PMC10610003 DOI: 10.3390/pharmaceutics15102488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The clinical outcomes of antiretroviral drugs may be modified through drug interactions; thus, it is important to update the drug interactions in people living with HIV (PLHIV). AIM To update clinically relevant drug interactions in PLHIV on antiretroviral therapy with novel drug interactions published from 2017 to 2022. METHODS A systematic review in Medline/PubMed database from July 2017 to December 2022 using the Mesh terms antiretroviral agents and drug interactions or herb-drug interactions or food-drug interactions. Publications with drug interactions in humans, in English or Spanish, and with full-text access were retrieved. The clinical relevance of drug interactions was grouped into five levels according to the gravity and probability of occurrence. RESULTS A total of 366 articles were identified, with 219 (including 87 citation lists) were included, which allowed for the identification of 471 drug interaction pairs; among them, 291 were systematically reported for the first time. In total 42 (14.4%) and 137 (47.1%) were level one and two, respectively, and 233 (80.1%) pairs were explained with the pharmacokinetic mechanism. Among these 291 pairs, protease inhibitors (PIs) and ritonavir/cobicistat-boosted PIs, as well as integrase strand transfer inhibitors (InSTIs), with 70 (24.1%) and 65 (22.3%) drug interaction pairs of levels one and two, respectively, were more frequent. CONCLUSIONS In PLHIV on antiretroviral therapy, we identify 291 drug interaction pairs systematically reported for the first time, with 179 (61.5%) being assessed as clinically relevant (levels one and two). The pharmacokinetic mechanism was the most frequently identified. PIs, ritonavir/cobicistat-boosted PIs, and InSTIs were the antiretroviral groups with the highest number of clinically relevant drug interaction pairs (levels one and two).
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Affiliation(s)
- Pedro Amariles
- Research Group on Pharmaceutical Promotion and Prevention, University of Antioquia, UdeA, AA 1226, Medellin 050010, Colombia; (M.R.-C.); (M.C.)
- Research Group on Pharmaceutical Care, University of Granada, 18071 Granada, Spain
| | - Mónica Rivera-Cadavid
- Research Group on Pharmaceutical Promotion and Prevention, University of Antioquia, UdeA, AA 1226, Medellin 050010, Colombia; (M.R.-C.); (M.C.)
| | - Mauricio Ceballos
- Research Group on Pharmaceutical Promotion and Prevention, University of Antioquia, UdeA, AA 1226, Medellin 050010, Colombia; (M.R.-C.); (M.C.)
- Research Group on Pharmacy Regency Technology, University of Antioquia, Medellin 050010, Colombia
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17
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Khan A, Paneerselvam N, Lawson BR. Antiretrovirals to CCR5 CRISPR/Cas9 gene editing - A paradigm shift chasing an HIV cure. Clin Immunol 2023; 255:109741. [PMID: 37611838 PMCID: PMC10631514 DOI: 10.1016/j.clim.2023.109741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/18/2023] [Accepted: 08/13/2023] [Indexed: 08/25/2023]
Abstract
The evolution of drug-resistant viral strains and anatomical and cellular reservoirs of HIV pose significant clinical challenges to antiretroviral therapy. CCR5 is a coreceptor critical for HIV host cell fusion, and a homozygous 32-bp gene deletion (∆32) leads to its loss of function. Interestingly, an allogeneic HSCT from an HIV-negative ∆32 donor to an HIV-1-infected recipient demonstrated a curative approach by rendering the recipient's blood cells resistant to viral entry. Ex vivo gene editing tools, such as CRISPR/Cas9, hold tremendous promise in generating allogeneic HSC grafts that can potentially replace allogeneic ∆32 HSCTs. Here, we review antiretroviral therapeutic challenges, clinical successes, and failures of allogeneic and allogeneic ∆32 HSCTs, and newer exciting developments within CCR5 editing using CRISPR/Cas9 in the search to cure HIV.
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Affiliation(s)
- Amber Khan
- The Scintillon Research Institute, 6868 Nancy Ridge Drive, San Diego, CA 92121, USA
| | | | - Brian R Lawson
- The Scintillon Research Institute, 6868 Nancy Ridge Drive, San Diego, CA 92121, USA.
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18
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Cardoso-Neto ÉC, Netto EM, Brites C. Weight gain in patients starting Dolutegravir-based ART according to baseline CD4 count after 48 weeks of follow up. Braz J Infect Dis 2023; 27:102807. [PMID: 37788801 PMCID: PMC10569987 DOI: 10.1016/j.bjid.2023.102807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/28/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Excessive weight gain is a current concern among People Living with HIV (PLHIV) starting ART. OBJECTIVES To evaluate the weight gain after 48-weeks of ART in naive patients, according with baseline CD4 count. METHODS PLHIV starting 3TC + TDF + DTG with at least 48-weeks of follow up in two AIDS referral centers were stratified by baseline CD4 count (lower or higher than 200 cells/mm3). Data on CD4 count, HIV viral load, weight/Body Mass Index (BMI), lipids and glucose levels were collected at baseline, 24 and 48 weeks of treatment. For analysis purpose, patients were categorized according to their BMI progression. RESULTS A total of 270 patients were included in the study. Mean CD4 count were 78.3 ± 61.7 and 536.7 ± 273 cells/mm3 for low and high CD4 count groups, respectively (p < 0.001). Baseline BMI was significantly lower in low CD4 group (21.7 vs. 23.6 Kg/m2, p < 0.001). Patients in low CD4 group gained more weight than those in high CD4 group (11.2 ± 8.5 kg vs. 2.2 ± 4.2 Kg, p = 0.004). Overall weight gain was higher in women, regardless group (13.1 ± 7.9 Kg vs. 1.4 ± 3.6 Kg for women and men, respectively, p < 0.001). The proportion of overweight/obesity significantly increased in low CD4 group. Viral suppression rate was high for both groups. At week 48 the overall proportion of overweight/obesity was like that reported for the Brazilian population. CONCLUSIONS Weight gain in the present study indicates a "return to health" phenomenon. Excessive weight gain was more frequent in women.
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Affiliation(s)
| | | | - Carlos Brites
- Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil; Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brazil.
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19
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Amod F, Holla VV, Ojha R, Pandey S, Yadav R, Pal PK. A review of movement disorders in persons living with HIV. Parkinsonism Relat Disord 2023; 114:105774. [PMID: 37532621 DOI: 10.1016/j.parkreldis.2023.105774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/22/2023] [Accepted: 07/22/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND The human immunodeficiency virus (HIV) causes movement disorders in persons living with HIV (PLH). OBJECTIVES AND METHODS We conducted a systematic review on the spectrum of movement disorders in PLH using standard terms for each of the phenomenologies and HIV. RESULTS Movement disorders in PLH were commonly attributed to opportunistic infections (OI), dopamine receptor blockade reactions, HIV-associated dementia (HAD), presented during seroconversion, developed due to drug reactions or antiretroviral therapy (ART) itself and lastly, movement disorders occurred as a consequence of the HIV-virus. Parkinsonism in ART naïve PLH was associated with shorter survival, however when Parkinsonism presented in PLH on ART, the syndrome was indistinguishable from Idiopathic Parkinson's disease and responded to therapy. Tremor was often postural due to HAD, drugs or OI. Generalized chorea was most frequent in HIV encephalopathy and toxoplasmosis gondii caused most cases of hemichorea. Ataxia was strongly associated with JCV infection, ART efavirenz toxicity or due to HIV itself. Dystonia was reported in HAD, secondary to drugs and atypical facial dystonias. Both cortical/subcortical and segmental/spinal origin myoclonus were noted mainly associated with HAD. In patients with HIV related opsoclonus-myoclonus-ataxia-syndrome, seroconversion illness was the commonest cause of followed by IRIS and CSF HIV viral escape phenomenon. CONCLUSIONS Aetiology of movement disorders in PLH depend on the treatment state. Untreated, PLH are prone to develop OI and HAD and movement disorders. However, as the number of PLH on ART increase and survive longer, the frequency of ART and non-AIDS related complications are likely to increase.
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Affiliation(s)
- Ferzana Amod
- Department of Neurology, University of KwaZulu-Natal, South Africa.
| | - Vikram V Holla
- National Institute of Mental Health and Neuro Sciences, Bengaluru, India.
| | - Rajeev Ojha
- Department of Neurology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
| | - Sanjay Pandey
- Department of Neurology and Stroke Medicine, Amrita Hospital, Delhi National Capital Region, India.
| | - Ravi Yadav
- National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India.
| | - Pramod Kumar Pal
- National Institute of Mental Health and Neuro Sciences, Bangalore, India.
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20
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Foka FET, Mufhandu HT. Current ARTs, Virologic Failure, and Implications for AIDS Management: A Systematic Review. Viruses 2023; 15:1732. [PMID: 37632074 PMCID: PMC10458198 DOI: 10.3390/v15081732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Antiretroviral therapies (ARTs) have revolutionized the management of human immunodeficiency virus (HIV) infection, significantly improved patient outcomes, and reduced the mortality rate and incidence of acquired immunodeficiency syndrome (AIDS). However, despite the remarkable efficacy of ART, virologic failure remains a challenge in the long-term management of HIV-infected individuals. Virologic failure refers to the persistent detectable viral load in patients receiving ART, indicating an incomplete suppression of HIV replication. It can occur due to various factors, including poor medication adherence, drug resistance, suboptimal drug concentrations, drug interactions, and viral factors such as the emergence of drug-resistant strains. In recent years, extensive efforts have been made to understand and address virologic failure in order to optimize treatment outcomes. Strategies to prevent and manage virologic failure include improving treatment adherence through patient education, counselling, and supportive interventions. In addition, the regular monitoring of viral load and resistance testing enables the early detection of treatment failure and facilitates timely adjustments in ART regimens. Thus, the development of novel antiretroviral agents with improved potency, tolerability, and resistance profiles offers new options for patients experiencing virologic failure. However, new treatment options would also face virologic failure if not managed appropriately. A solution to virologic failure requires a comprehensive approach that combines individualized patient care, robust monitoring, and access to a range of antiretroviral drugs.
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Affiliation(s)
- Frank Eric Tatsing Foka
- Department of Microbiology, Virology Laboratory, School of Biological Sciences, Faculty of Natural and Agricultural Sciences, North West University, Mafikeng, Private Bag, Mmabatho X2046, South Africa
| | - Hazel Tumelo Mufhandu
- Department of Microbiology, Virology Laboratory, School of Biological Sciences, Faculty of Natural and Agricultural Sciences, North West University, Mafikeng, Private Bag, Mmabatho X2046, South Africa
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Han S, Lu Y. Fluorine in anti-HIV drugs approved by FDA from 1981 to 2023. Eur J Med Chem 2023; 258:115586. [PMID: 37393791 DOI: 10.1016/j.ejmech.2023.115586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Abstract
Human immunodeficiency virus (HIV) is the etiological agent of acquired immunodeficiency syndrome (AIDS). Nowadays, FDA has approved over thirty antiretroviral drugs grouped in six categories. Interestingly, one-third of these drugs contain different number of fluorine atoms. The introduction of fluorine to obtain drug-like compounds is a well-accepted strategy in medicinal chemistry. In this review, we summarized 11 fluorine-containing anti-HIV drugs, focusing on their efficacy, resistance, safety, and specific roles of fluorine in the development of each drug. These examples may be of help for the discovery of new drug candidates bearing fluorine in their structures.
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Affiliation(s)
- Sheng Han
- School of Medicine, Shanghai University, Shanghai, China.
| | - Yiming Lu
- School of Medicine, Shanghai University, Shanghai, China; Department of Critical Care Medicine, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
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22
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Salvo PF, Farinacci D, Ciccullo A, Borghi V, Rusconi S, Saracino A, Gennari W, Bruzzone B, Vicenti I, Callegaro A, Di Biagio A, Zazzi M, Di Giambenedetto S, Borghetti A. Efficacy of Dolutegravir versus Darunavir in Antiretroviral First-Line Regimens According to Resistance Mutations and Viral Subtype. Viruses 2023; 15:v15030762. [PMID: 36992471 PMCID: PMC10059835 DOI: 10.3390/v15030762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
Background: Dolutegravir (DTG)-based first-line regimens have shown superior efficacy versus darunavir (DRV)-based ones in randomized trials. We compared these two strategies in clinical practice, particularly considering the role of pre-treatment drug resistance mutations (DRMs) and of the HIV-1 subtype. Materials and methods: The multicenter Antiretroviral Resistance Cohort Analysis (ARCA) database was queried to identify HIV-1-positive patients starting a first-line therapy with 2NRTIs plus either DTG or DRV between 2013 and 2019. Only adult (≥18 years) patients with a genotypic resistance test (GRT) prior to therapy and with HIV-1 RNA ≥1000 copies/mL were selected. Through multivariable Cox regressions, we compared DTG- versus DRV-based regimens in the time to virological failure (VF) stratifying for pre-treatment DRMs and the viral subtype. Results: A total of 649 patients was enrolled, with 359 (55.3%) and 290 (44.7) starting DRV and DTG, respectively. In 11 months of median follow-up time, there were 41 VFs (8.4 in 100 patient-years follow-up, PYFU) and 15 VFs (5.3 per 100 PYFU) in the DRV and DTG groups, respectively. Compared with a fully active DTG-based regimen, the risk of VF was higher with DRV (aHR 2.33; p = 0.016), and with DTG-based regimens with pre-treatment DRMs to the backbone (aHR 17.27; p = 0.001), after adjusting for age, gender, baseline CD4 count and HIV-RNA, concurrent AIDS-defining event and months since HIV diagnosis. Compared with patients harboring a B viral subtype and treated with a DTG-based regimen, patients on DRV had an increased risk of VF, both in subtype B (aHR 3.35; p = 0.011), C (aHR 8.10; p = 0.005), CRF02-AG (aHR 5.59; p = 0.006) and G (aHR 13.90; p < 0.001); DTG also demonstrated a reduced efficacy in subtypes C (versus B, aHR 10.24; p = 0.035) and CRF01-AE (versus B; aHR 10.65; p = 0.035). Higher baseline HIV-RNA and a longer time since HIV diagnosis also predicted VF. Conclusions: In line with randomized trials, DTG-based first-line regimens showed an overall superior efficacy compared with DRV-based regimens. GRT may still play a role in identifying patients more at risk of VF and in guiding the choice of an antiretroviral backbone.
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Affiliation(s)
- Pierluigi Francesco Salvo
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence:
| | - Damiano Farinacci
- UOC Medicina Protetta–Malattie Infettive–ASL Viterbo, 0100 Viterbo, Italy
| | - Arturo Ciccullo
- Malattie Infettive, Ospedale San Salvatore, 67100 L’Aquila, Italy
| | - Vanni Borghi
- Clinica delle Malattie Infettive e Tropicali dell’Università di Modena e Reggio Emilia, 41100 Modena, Italy
| | - Stefano Rusconi
- UOC Malattie Infettive, Ospedale Civile di Legnano, ASST Ovest Milanese, 20025 Legnano, Italy
| | - Annalisa Saracino
- Clinica Malattie Infettive, Università degli Studi di Bari, 70121 Bari, Italy
| | - William Gennari
- Clinica delle Malattie Infettive e Tropicali dell’Università di Modena e Reggio Emilia, 41100 Modena, Italy
| | - Bianca Bruzzone
- Hygiene Unit, Policlinico San Martino Hospital, 16126 Genoa, Italy
| | - Ilaria Vicenti
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Annapaola Callegaro
- Microbiology and Virology Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Policlinico San Martino Hospital, Department of Health Sciences (DISSAL), University of Genoa, 16126 Genoa, Italy
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Simona Di Giambenedetto
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A.Gemelli IRCCS, 00168 Rome, Italy
| | - Alberto Borghetti
- UOC Malattie Infettive, Fondazione Policlinico Universitario A.Gemelli IRCCS, 00168 Rome, Italy
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Burdon RM, Atefi D, Rana J, Parasuraman A, Lee AS, Nield B. Sustained Mpox Proctitis with Primary Syphilis and HIV Seroconversion, Australia. Emerg Infect Dis 2023; 29:647-649. [PMID: 36703251 PMCID: PMC9973693 DOI: 10.3201/eid2903.221845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A 26-year-old man in Australia who has sex with men had severe perianal ulceration, proctitis, and skin lesions develop. Testing revealed primary syphilis, mpox, and primary HIV infection. Recent publications have documented severe mpox associated with HIV infection. Disruption of mucosal integrity by mpox lesions could enable HIV transmission and vice versa.
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Nair AB, Chaudhary S, Jacob S, Patel D, Shinu P, Shah H, Chaudhary A, Aldhubiab B, Almuqbil RM, Alnaim AS, Alqattan F, Shah J. Intranasal Administration of Dolutegravir-Loaded Nanoemulsion-Based In Situ Gel for Enhanced Bioavailability and Direct Brain Targeting. Gels 2023; 9:gels9020130. [PMID: 36826300 PMCID: PMC9956165 DOI: 10.3390/gels9020130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
Dolutegravir's therapeutic effectiveness in the management of neuroAIDS is mainly limited by its failure to cross the blood-brain barrier. However, lipid-based nanovesicles such as nanoemulsions have demonstrated their potential for the brain targeting of various drugs by intranasal delivery. Thus, the purpose of this study was to develop a Dolutegravir-loaded nanoemulsion-based in situ gel and evaluate its prospective for brain targeting by intranasal delivery. Dolutegravir-loaded nanoemulsions were prepared using dill oil, Tween® 80, and Transcutol® P. Optimization of the nanoemulsion particle size and drug release was carried out using a simplex lattice design. Formulations (F1-F7 and B1-B6) were assessed for various pharmaceutical characteristics. Ex vivo permeation and ciliotoxicity studies of selected in situ gels (B1) were conducted using sheep nasal mucosa. Drug targeting to the brain was assessed in vivo in rats following the nasal delivery of B1. The composition of oil, surfactant, and cosurfactant significantly (p < 0.05) influenced the dependent variables (particle size and % of drug release in 8 h). Formulation B1 exhibits pharmaceutical characteristics that are ideal for intranasal delivery. The mucosal steady-state flux noticed with BI was significantly greater (p < 0.005) than for the control gel. A histopathology of nasal mucosa treated with BI showed no signs of toxicity or cellular damage. Intranasal administration of B1 resulted in greater Cmax (~six-fold, p < 0.0001) and AUC0-α (~five-fold, p < 0.0001), and decreased Tmax (1 h) values in the brain, compared to intravenous administration. Meantime, the drug level in the plasma was relatively low, suggesting less systemic exposure to Dolutegravir through intranasal delivery. In summary, the promising data observed here signifies the prospective of B1 to enhance the brain targeting of Dolutegravir by intranasal delivery and it could be used as a feasible and practicable strategy for the management of neuroAIDS.
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Affiliation(s)
- Anroop B. Nair
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- Correspondence: (A.B.N.); (J.S.); Tel.: +966-536219868 (A.B.N.); +91-9909007411 (J.S.)
| | - Sunita Chaudhary
- Department of Pharmaceutics, Arihant School of Pharmacy & BRI, Adalaj, Gandhinagar 382421, India
| | - Shery Jacob
- Department of Pharmaceutical Sciences, College of Pharmacy, Gulf Medical University, Ajman 4184, United Arab Emirates
| | - Dhwani Patel
- Department of Pharmaceutics, Arihant School of Pharmacy & BRI, Adalaj, Gandhinagar 382421, India
| | - Pottathil Shinu
- Department of Biomedical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Hiral Shah
- Department of Pharmaceutics, Arihant School of Pharmacy & BRI, Adalaj, Gandhinagar 382421, India
| | - Ankit Chaudhary
- Department of Quality Assurance, Saraswati Institute of Pharmaceutical Sciences, Gandhinagar 382355, India
| | - Bandar Aldhubiab
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Rashed M. Almuqbil
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Ahmed S. Alnaim
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Fatemah Alqattan
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Jigar Shah
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad 382481, India
- Correspondence: (A.B.N.); (J.S.); Tel.: +966-536219868 (A.B.N.); +91-9909007411 (J.S.)
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25
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Overmars RJ, Krullaars Z, Mesplède T. Investigational drugs for HIV: trends, opportunities and key players. Expert Opin Investig Drugs 2023; 32:127-139. [PMID: 36751107 DOI: 10.1080/13543784.2023.2178415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Since the first antiretroviral drug was described, the field of HIV treatment and prevention has undergone two drug-based revolutions: the first one, enabled by the virtually concomitant discovery of non-nucleoside reverse transcriptase and protease inhibitors, was the inception of combined antiretroviral therapy. The second followed the creation of integrase strand-transfer inhibitors with improved safety, potency, and resistance profiles. Long-acting antiretroviral drugs, including broadly neutralizing antibodies, now offer the opportunity for a third transformational change in HIV management. AREAS COVERED Our review focused on HIV treatment and prevention with investigational drugs that offer the potential for infrequent dosing, including drugs not yet approved for clinical use. We also discussed approved drugs for which administration modalities or formulations are being optimized. We performed a literature search in published manuscripts, conference communications, and registered clinical trials. EXPERT OPINION While the field focuses on extending dosing intervals, we identify drug tissue penetration as an understudied opportunity to improve HIV care. We repeat that self-administration remains an essential milestone to reach the full potential of long-acting drugs. Treatments and prevention strategies based on broadly neutralizing antibodies require a deeper understanding of their antiretroviral properties.
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Affiliation(s)
- Ronald J Overmars
- Viroscience Department, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Zoë Krullaars
- Viroscience Department, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Thibault Mesplède
- Viroscience Department, Erasmus Medical Center, Rotterdam, The Netherlands
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