Targeting HIV-TB coinfection by developing novel piperidin-4-substituted imines: Design, synthesis, in vitro and in silico studies

A Review of the Development of Multitarget Molecules against HIV-TB Coinfection Pathogens

The human immunodeficiency virus (HIV) produces the pathologic basis of acquired immunodeficiency syndrome (AIDS). An increase in the viral load in the body leads to a decline in the number of T lymphocytes, compromising the patient's immune system. Some opportunistic diseases may result, such as tuberculosis (TB), which is the most common in seropositive patients. Long-term treatment is required for HIV-TB coinfection, and cocktails of drugs for both diseases are used concomitantly. The most challenging aspects of treatment are the occurrence of drug interactions, overlapping toxicity, no adherence to treatment and cases of resistance. Recent approaches have involved using molecules that can act synergistically on two or more distinct targets. The development of multitarget molecules could overcome the disadvantages of the therapies used to treat HIV-TB coinfection. This report is the first review on using molecules with activities against HIV and Mycobacterium tuberculosis (MTB) for molecular hybridization and multitarget strategies. Here, we discuss the importance and development of multiple targets as a means of improving adherence to therapy in cases of the coexistence of these pathologies. In this context, several studies on the development of structural entities to treat HIV-TB simultaneously are discussed.

Predictors of death among TB/HIV co-infected patients on tuberculosis treatment in Sichuan, China: A retrospective cohort study

Mycobacterium tuberculosis is the most common opportunistic infection among patients with human immunodeficiency virus (HIV) infection, and it is also the leading cause of death, causing approximately one-third of acquired immune deficiency syndrome deaths worldwide. China is on the World Health Organization's global list of 30 high-tuberculosis (TB) burden countries. The objective of this study was to evaluate the mortality rate, survival probabilities, and factors associated with death among patients with TB/HIV co-infection undergoing TB treatment in Sichuan, China. A retrospective cohort study was conducted using the Chinese National TB Surveillance System data of TB/HIV co-infected patients enrolled in TB treatment from January 2020 to December 2020. We calculated the mortality rate and survival probabilities using the Kaplan-Meier estimator, and a Cox proportional hazard model was conducted to identify independent risk factors for TB/HIV co-infection mortality. Hazard ratios and their respective 95% confidence intervals were also reported in this study. Of 828 TB/HIV co-infected patients, 44 (5.31%) died during TB treatment, and the crude mortality rate was 7.76 per 1000 person-months. More than half of the deaths (n = 23) occurred in the first 3 months of TB treatment. Overall survival probabilities were 97.20%, 95.16%, and 91.75% at 3rd, 6th, and 12th month respectively. The independent risk factors for mortality among TB/HIV co-infected patients were having extra-pulmonary TB and pulmonary TB co-infection, history of antiretroviral therapy interruption, and baseline cluster of differentiation 4 T-lymphocyte counts <200 cells/μL at the time of HIV diagnosis. Antiretroviral therapy is important for the survival of TB/HIV co-infected patients, and it is recommended to help prolong life by restoring immune function and preventing extra-pulmonary TB.

e-Pharmacophore model-guided design of potential DprE1 inhibitors: synthesis, in vitro antitubercular assay and molecular modelling studies

Tuberculosis continues to wreak havoc worldwide and caused around 1.4 million deaths in 2019. Hence, in our pursuit of developing novel antitubercular compounds, we are reporting the e-Pharmacophore-based design of DprE1 (decaprenylphosphoryl-ribose 2′-oxidase) inhibitors. In the present work, we have developed a four-feature e-Pharmacophore model based on the receptor–ligand cavity of DprE1 protein (PDB ID 4P8C) and mapped our previous reported library of compounds against it. The compounds were ranked on phase screen score, and the insights obtained from their alignment were used to design some novel compounds. The designed compounds were docked with DprE1 protein in extra-precision mode using Glide module of Maestro, Schrodinger. Some derivatives like B1, B2, B4, B5 and B12 showed comparable docking score (docking score > − 6.0) with respect to the co-crystallized ligand. The designed compounds were synthesized and characterized. In vitro antitubercular activity was carried out on Mycobacterium tuberculosis H37Rv (ATCC27294) strain using the agar dilution method, and minimum inhibitory concentration (MIC) was determined. The compound B12 showed a MIC value of 1.56 μg/ml which was better than the standard drug ethambutol (3.125 μg/ml). Compounds B7 and B11 were found to be equipotent with ethambutol. Cytotoxicity studies against Vero cell lines proved that these compounds were non-cytotoxic. Molecular dynamic simulation study also suggests that compound B12 will form a stable complex with DprE1 protein and will show the crucial H-bond interaction with LYS418 residue. Further in vitro enzyme inhibition studies are required to validate these findings.