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Dravid AN, Pilawan AS, Anuradha S, Morkar DN, Ramapuram JT, Madhukarrao KM, Naik KS, Bhrusundi M, Raveendra K, Nageswaramma S, Kulkarni V. Safety of low dose efavirenz regimen in Indian adults with HIV-1 infection: Insights from a phase 4 interventional randomised trial. Medicine (Baltimore) 2023; 102:e35643. [PMID: 37933062 PMCID: PMC10627601 DOI: 10.1097/md.0000000000035643] [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: 07/12/2023] [Accepted: 09/22/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND A randomized interventional phase 4 study in the Indian population confirmed the non-inferiority of the combination tenofovir/lamivudine/efavirenz (TLE)-400 to TLE600. The current manuscript describes in detail the safety profile and patient-reported safety outcomes obtained from the phase 4 study. METHODS This investigation was part of a phase 4 non-inferiority study with a blinded assessment, conducted across 17 sites in India. The duration of the study was 24 weeks. Safety endpoints assessed included all the adverse events (AEs) related to the study treatment (TLE400 and TLE600). The depression anxiety stress 21-item scale questionnaire and efavirenz-related symptom questionnaire were also used to measure depression, anxiety, stress, and patient experience. RESULTS A total of 68 patients (52.3%) reported 261 AEs and 87 patients (64.9%) reported 379 AEs related to study treatment in TLE400 group and TLE600 group respectively, P = .037. The reported AEs associated with central nervous system disorders were lower in the TLE400 group with 41 patients (31.5%) to 61 patients (45.5%) in the TLE600 group. The change from mean baseline value for depression anxiety stress 21-item scale at week 28 in TLE400 group and TLE600 group was -5.1 and -6.2 respectively. Similarly, the mean change from baseline score of efavirenz-related symptoms at week 28 in TLE400 group and TLE600 group were -5.1 and -4.1 respectively. CONCLUSION The low dose efavirenz (400 mg) in combination with tenofovir and lamivudine had a better safety and tolerability profile than the standard dose of efavirenz (600 mg) in combination with tenofovir and lamivudine. Thus, low dose efavirenz should be preferred over the standard dose.
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Affiliation(s)
- Ameet N. Dravid
- Department of Medicine, Poona Hospital and Research Centre, Maharashtra, India
| | - Anant S. Pilawan
- Department of Medicine, Government Medical College & Hospital, Maharashtra, India
| | - S. Anuradha
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | | | | | | | - K. Sunil Naik
- Department of Medicine, Rajiv Gandhi Institute of Medical Science and RIMS Government General Hospital, Andhra Pradesh, India
| | - Milind Bhrusundi
- Department of Medicine, NKP Salve Institute of Medical Sciences and Late Mangeshkar Hospital, Maharashtra, India
| | - K.R. Raveendra
- Department of Medicine, Bangalore Medical College and Research Institute, Karnataka, India
| | | | - Vinay Kulkarni
- Department of Dermatology, Deenanath Mangeshkar Hospital and Research Centre, Maharashtra, India
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Le Roux M, Möller M, Harvey BH. Prolonged efavirenz exposure reduces peripheral oxytocin and vasopressin comparable to known drugs of addiction in male Sprague Dawley rats. IBRO Neurosci Rep 2021; 11:56-63. [PMID: 34939063 PMCID: PMC8664698 DOI: 10.1016/j.ibneur.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 03/03/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Several drugs of abuse (DOA) are capable of modulating neurohypophysial hormones, such as oxytocin (OT) and vasopressin (VP), potentially resulting in the development of psychological abnormalities, such as cognitive dysfunction, psychoses, and affective disorders. Efavirenz (EFV), widely used in Africa and globally to treat HIV, induces diverse neuropsychiatric side effects while its abuse has become a global concern. The actions of EFV may involve neurohypophysial system (NS) disruption like that of known DOA. This study investigated whether sub-chronic EFV exposure, at a previously-determined rewarding dose, alters peripheral OT and VP levels versus that of a control, ∆9-tetrahydrocannabinol (∆9-THC), methamphetamine (MA) and cocaine. MATERIALS AND METHODS To simulate the conditions under which reward-driven behavior had previously been established for EFV, male Sprague Dawley rats (n = 16/exposure) received intraperitoneal vehicle (control) or drug administration across an alternating sixteen-day dosing protocol. Control administration (saline/olive oil; 0.2 ml) occurred on odd-numbered and drug administration (EFV: 5 mg/kg, ∆9-THC: 0.75 mg/kg, MA: 1 mg/kg, or cocaine: 20 mg/kg) on even-numbered days followed by euthanasia, trunk blood collection and plasma extraction for neuropeptide assay. Effect of drug exposure on peripheral OT and VP levels was assessed versus controls and quantified using specific ELISA kits. Statistical significance was determined by Kruskal-Wallis ANOVA, with p < 0.05. Ethics approval: NWU-00291-17-A5. RESULTS Delta-9-THC reduced OT and VP plasma levels (p < 0.0001, p = 0.0141; respectively), cocaine reduced plasma OT (p = 0.0023), while MA reduced plasma VP levels (p = 0.0001), all versus control. EFV reduced OT and VP plasma levels (p < 0.0001; OT and VP) versus control, and similar to ∆9-THC. CONCLUSION EFV markedly affects the NS in significantly reducing both plasma OT and VP equivalent to DOA. Importantly, EFV has distinct effects on peripheral OT and VP levels when assessed within the context of drug dependence. The data highlights a possible new mechanism underlying previously documented EFV-induced effects in rats, and whereby EFV may induce neuropsychiatric adverse effects clinically; also providing a deeper understanding of the suggested abuse-potential of EFV.
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Key Words
- 5-HT, 5-hydroxytryptamine (serotonin)
- ADH, antidiuretic hormone
- AEA, N-arachidonoylethanolamine (anandamide)
- ANOVA, one-way analysis of variance
- ARRIVE, animal research: reporting of in vivo experiments (guidelines)
- ARV, antiretroviral
- Ach, acetylcholine
- CB, cannabinoid
- CNS, central nervous system
- CPP, conditioned place preference
- Cocaine
- DA, dopamine
- DAT, dopamine transporter
- DOA‘s, drug(s) of abuse
- ECS, endocannabinoid system
- EFV, efavirenz
- ELISA, enzyme-linked immunosorbent assay
- Efavirenz
- GABA, gamma-aminobutyric acid
- Glu, glutamate
- HIV, human immunodeficiency virus
- HNS, hypothalamic neurohypophysial system
- HPA, hypothalamic-pituitary-adrenal (axis)
- IP, intraperitoneal
- IV, intravenous
- M, muscarinic
- MA, methamphetamine
- MAO, monoamine oxidase
- Methamphetamine
- NAc, nucleus accumbens
- NE, norepinephrine
- NO, nitric oxide
- NPAE, neuropsychiatric adverse effect
- OT, oxytocin
- OTR, oxytocin receptor
- Oxytocin
- PND, postnatal day
- PVN, paraventricular nucleus
- SC, subcutaneous
- SD, Sprague Dawley (rat)
- SEM, standard error of the mean
- SERT, serotonin transporter
- SON, supraoptic nucleus
- VMAT, vesicular monoamine transporter
- VP, vasopressin
- VPR, vasopressin receptor
- Vasopressin
- cART, combined antiretroviral therapy
- ∆9-THC, delta-9-tetrahydrocannabinol
- ∆9-tetrahydrocannabinol
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Affiliation(s)
- Mandi Le Roux
- Division of Pharmacology, School of Pharmacy, North-West University, Potchefstroom, South Africa
- Centre of Excellence for Pharmaceutical Sciences (PharmaCenTM), School of Pharmacy, North-West University, Potchefstroom, South Africa
| | - Marisa Möller
- Division of Pharmacology, School of Pharmacy, North-West University, Potchefstroom, South Africa
- Centre of Excellence for Pharmaceutical Sciences (PharmaCenTM), School of Pharmacy, North-West University, Potchefstroom, South Africa
| | - Brian H. Harvey
- Division of Pharmacology, School of Pharmacy, North-West University, Potchefstroom, South Africa
- Centre of Excellence for Pharmaceutical Sciences (PharmaCenTM), School of Pharmacy, North-West University, Potchefstroom, South Africa
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McLaurin KA, Harris M, Madormo V, Harrod SB, Mactutus CF, Booze RM. HIV-Associated Apathy/Depression and Neurocognitive Impairments Reflect Persistent Dopamine Deficits. Cells 2021; 10:2158. [PMID: 34440928 PMCID: PMC8392364 DOI: 10.3390/cells10082158] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/10/2021] [Accepted: 08/18/2021] [Indexed: 12/12/2022] Open
Abstract
Individuals living with human immunodeficiency virus type 1 (HIV-1) are often plagued by debilitating neurocognitive impairments and affective alterations;the pathophysiology underlying these deficits likely includes dopaminergic system dysfunction. The present review utilized four interrelated aims to critically examine the evidence for dopaminergic alterations following HIV-1 viral protein exposure. First, basal dopamine (DA) values are dependent upon both brain region andexperimental approach (i.e., high-performance liquid chromatography, microdialysis or fast-scan cyclic voltammetry). Second, neurochemical measurements overwhelmingly support decreased DA concentrations following chronic HIV-1 viral protein exposure. Neurocognitive impairments, including alterations in pre-attentive processes and attention, as well as apathetic behaviors, provide an additional line of evidence for dopaminergic deficits in HIV-1. Third, to date, there is no compelling evidence that combination antiretroviral therapy (cART), the primary treatment regimen for HIV-1 seropositive individuals, has any direct pharmacological action on the dopaminergic system. Fourth, the infection of microglia by HIV-1 viral proteins may mechanistically underlie the dopamine deficit observed following chronic HIV-1 viral protein exposure. An inclusive and critical evaluation of the literature, therefore, supports the fundamental conclusion that long-term HIV-1 viral protein exposure leads to a decreased dopaminergic state, which continues to persist despite the advent of cART. Thus, effective treatment of HIV-1-associated apathy/depression and neurocognitive impairments must focus on strategies for rectifying decreases in dopamine function.
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Affiliation(s)
| | | | | | | | | | - Rosemarie M. Booze
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA; (K.A.M.); (M.H.); (V.M.); (S.B.H.); (C.F.M.)
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Arias HR, Do Rego JL, Do Rego JC, Chen Z, Anouar Y, Scholze P, Gonzales EB, Huang R, Chagraoui A. Coronaridine congeners potentiate GABA A receptors and induce sedative activity in mice in a benzodiazepine-insensitive manner. Prog Neuropsychopharmacol Biol Psychiatry 2020; 101:109930. [PMID: 32194202 DOI: 10.1016/j.pnpbp.2020.109930] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 12/23/2022]
Abstract
To determine whether (+)-catharanthine induces sedative- or anxiolytic/anxiogenic-like activity in male mice, proper animal paradigms were used. The results showed that (+)-catharanthine induces sedative-like activity in the 63-72 mg/Kg dose range in a flumazenil-insensitive manner, but neither this effect nor anxiolytic/anxiogenic-like activity was observed at lower doses. To determine the underlying molecular mechanism of the sedative-like activity, electrophysiological and radioligand binding experiments were performed with (+)-catharanthine and (±)-18-methoxycoronaridine [(±)-18-MC] on GABAA (GABAARs) and glycine receptors (GlyRs). Coronaridine congeners both activated and potentiated a variety of human (h) GABAARs, except hρ1. (+)-Catharanthine-induced potentiation followed this receptor selectivity (EC50's in μM): hα1β2 (4.6 ± 0.8) > hα2β2γ2 (12.6 ± 3.8) ~ hα1β2γ2 (14.4 ± 4.6) indicating that both α1 and α2 are equally important, whereas γ2 is not necessary. (+)-Catharanthine was >2-fold more potent and efficient than (±)-18-MC at hα1β2γ2. (+)-Catharanthine also potentiated, whereas (±)-18-MC inhibited, hα1 GlyRs with very low potency. Additional [3H]-flunitrazepam competition binding experiments using rat cerebellum membranes clearly demonstrated that these ligands do not bind to the benzodiazepine site. This is supported by the observed activity at hα1β2 (lacking the BDZ site) and similar effects between α1- and α2-containing GABAARs. Our study shows, for the first time, that (+)-catharanthine induced sedative-like effects in mice, and coronaridine congeners potentiated human α1β2γ2, α1β2, and hα2β2γ2, but not ρ1, GABAARs, both in a benzodiazepine-insensitive fashion, whereas only (+)-catharanthine slightly potentiated GlyRs.
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Affiliation(s)
- Hugo R Arias
- Department of Pharmacology and Physiology, Oklahoma State University College of Osteopathic Medicine, Tahlequah, OK, USA.
| | - Jean Luc Do Rego
- Behavioral Analysis Platform SCAC, Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen Normandy, Rouen, France
| | - Jean Claude Do Rego
- Behavioral Analysis Platform SCAC, Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen Normandy, Rouen, France
| | - Zhenglan Chen
- Department of Pharmacology and Neuroscience, Institute for Health Aging, University of North Texas Health Science Center at Fort Worth, TX, USA
| | - Youssef Anouar
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Normandie University, UNIROUEN, INSERM U1239, Institute for Research and Innovation in Biomedicine of Normandy (IRIB) Rouen, France
| | - Petra Scholze
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Eric B Gonzales
- Department of Pharmacology and Neuroscience, Institute for Health Aging, University of North Texas Health Science Center at Fort Worth, TX, USA
| | - Renqi Huang
- Department of Pharmacology and Neuroscience, Institute for Health Aging, University of North Texas Health Science Center at Fort Worth, TX, USA
| | - Abdeslam Chagraoui
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Normandie University, UNIROUEN, INSERM U1239, Institute for Research and Innovation in Biomedicine of Normandy (IRIB) Rouen, France; Department of Medical Biochemistry, Rouen University Hospital, CHU de Rouen, France.
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Chang JL, Tsai AC, Musinguzi N, Haberer JE, Boum Y, Muzoora C, Bwana M, Martin JN, Hunt PW, Bangsberg DR, Siedner MJ. Depression and Suicidal Ideation Among HIV-Infected Adults Receiving Efavirenz Versus Nevirapine in Uganda: A Prospective Cohort Study. Ann Intern Med 2018; 169:146-155. [PMID: 29946683 PMCID: PMC6475600 DOI: 10.7326/m17-2252] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Evidence regarding potential adverse neuropsychiatric effects of efavirenz is conflicting, and data from sub-Saharan Africa, where 70% of persons living with HIV (PLHIV) reside and efavirenz is used as first-line therapy, are limited. OBJECTIVE To estimate associations between efavirenz use and depression and suicidal ideation among PLHIV in Uganda. DESIGN Prospective observational cohort study. (ClinicalTrials.gov: NCT01596322). SETTING Mbarara, Uganda. PARTICIPANTS Adult PLHIV enrolled at the start of antiretroviral therapy (ART) and observed every 3 to 4 months from 2005 to 2015. MEASUREMENTS The exposure of interest was time-varying efavirenz use, defined as use during the 7 days and in 60 or more of the 90 days before a study visit, compared with nevirapine use. Self-reported outcomes were depression, defined as a mean score greater than 1.75 on the Hopkins Symptom Checklist depression subscale, and suicidal ideation. Multivariable-adjusted generalized estimating equations (GEE) logistic regression, Cox proportional hazards regression, and marginal structural models were fit to estimate the association between efavirenz use and the risk for depression and suicidal ideation. RESULTS 694 participants (median age, 33 years; median pretreatment CD4+ count, 1.8 × 109 cells/L) contributed 1200 person-years of observation (460 person-years receiving efavirenz). No baseline differences in depression or suicidal ideation were found between patients ever exposed to efavirenz and those never exposed to efavirenz and receiving nevirapine (P > 0.80 for both). Of 305 participants ever-exposed to efavirenz, 61 (20.0%) and 19 (6.2%) had depression and suicidal ideation, respectively, on at least 1 follow-up visit, compared with 125 (32.1%) and 47 (12.1%) of the 389 who received nevirapine. In adjusted GEE models, efavirenz use was associated with decreased odds of depression compared with nevirapine use (adjusted odds ratio, 0.62 [95% CI, 0.40 to 0.96]) and was not significantly associated with suicidal ideation (adjusted odds ratio, 0.61 [CI, 0.30 to 1.25]). Time-to-event and marginal structural models yielded similar estimates. LIMITATION Nonrandom assignment to treatment and substantial differences between the efavirenz and nevirapine groups. CONCLUSION No evidence was found that use of efavirenz in first-line ART increased the risk for depression or suicidal ideation compared with nevirapine use among PLHIV in Uganda. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Jonathan L Chang
- Duke University School of Medicine, Durham, North Carolina, and Massachusetts General Hospital, Boston, Massachusetts (J.L.C.)
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda (A.C.T., N.M., C.M., M.B.)
| | - Nicholas Musinguzi
- Mbarara University of Science and Technology, Mbarara, Uganda (A.C.T., N.M., C.M., M.B.)
| | - Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.E.H.)
| | - Yap Boum
- Mbarara University of Science and Technology, Mbarara, Uganda; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Epicentre Mbarara, Mbarara, Uganda (Y.B.)
| | - Conrad Muzoora
- Mbarara University of Science and Technology, Mbarara, Uganda (A.C.T., N.M., C.M., M.B.)
| | - Mwebesa Bwana
- Mbarara University of Science and Technology, Mbarara, Uganda (A.C.T., N.M., C.M., M.B.)
| | - Jeffrey N Martin
- University of California, San Francisco, San Francisco, California (J.N.M., P.W.H.)
| | - Peter W Hunt
- University of California, San Francisco, San Francisco, California (J.N.M., P.W.H.)
| | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda, and Oregon Health & Science University, Portland, Oregon (D.R.B.)
| | - Mark J Siedner
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, and Mbarara University of Science and Technology, Mbarara, Uganda (M.J.S.)
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Dalwadi DA, Ozuna L, Harvey BH, Viljoen M, Schetz JA. Adverse Neuropsychiatric Events and Recreational Use of Efavirenz and Other HIV-1 Antiretroviral Drugs. Pharmacol Rev 2018; 70:684-711. [DOI: 10.1124/pr.117.013706] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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