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Fernández A, Imaz A. Clinical considerations when switching antiretroviral therapy. Expert Rev Clin Pharmacol 2024; 17:565-577. [PMID: 38850057 DOI: 10.1080/17512433.2024.2365826] [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: 03/12/2024] [Accepted: 06/05/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION Antiretroviral therapy (ART) can be personalized through simple formulations with high resistance barriers, favorable safety profiles, and novel administration routes. Switching treatments has become a key clinical strategy for addressing drug toxicity and interactions and enhancing adherence and convenience. This strategy aims to improve the quality of life and long-term efficacy, even in challenging cases like people living with HIV (PLWH) with multiple comorbidities, prior virological failure, and drug resistance. AREAS COVERED The authors reviewed clinical trials and cohort studies providing evidence of benefits and risks of current antiretroviral (ARV) drugs as switching options for PLWH in various scenarios. The literature search included clinical trials, meta-analyses, observational studies, and review articles in English published after 2000, and current HIV treatment guidelines in English and Spanish as of February 2024. EXPERT OPINION New ARV drugs offer advantages in efficacy and safety over previous options but may also have adverse effects. Second-generation integrase inhibitors and tenofovir alafenamide show benefits as switching options in various scenarios, though more research is needed on potential weight gain and metabolic issues. Injectable long-acting ART is promising for switching strategies, but finding the optimal combination of new drugs remains challenging.
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Affiliation(s)
- Analuz Fernández
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arkaitz Imaz
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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2
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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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Jakimiuk A, Piechal A, Wiercińska-Drapało A, Nowaczyk A, Mirowska-Guzel D. Central nervous system disorders after use of dolutegravir: evidence from preclinical and clinical studies. Pharmacol Rep 2023; 75:1138-1151. [PMID: 37605102 PMCID: PMC10539422 DOI: 10.1007/s43440-023-00515-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023]
Abstract
The evaluation of dolutegravir based on available preclinical and clinical studies reveals a risk of central nervous system (CNS) disorders associated with long-term use of the drug. The available literature on the pharmacokinetics of the drug, including its penetration of the blood-brain barrier, was reviewed, as well as clinical trials assessing the incidence of adverse effects in the CNS and the frequency of its discontinuation. This paper also summarizes the impact of factors affecting the occurrence of CNS disorders and indicates the key role of pharmacovigilance in the process of supplementing knowledge on the safety of drugs, especially those that are newly registered.
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Affiliation(s)
- Alicja Jakimiuk
- Department of Clinical and Experimental Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, Banacha 1b, 02-097, Warsaw, Poland
| | - Agnieszka Piechal
- Department of Clinical and Experimental Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, Banacha 1b, 02-097, Warsaw, Poland
| | - Alicja Wiercińska-Drapało
- Department of Hepatology and Infectious and Tropical Diseases, Medical University of Warsaw, Provincial Infectious Diseases Hospital in Warsaw, Wolska 37, 01-201, Warsaw, Poland
| | - Alicja Nowaczyk
- Department of Organic Chemistry, Faculty of Pharmacy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 2 dr. A. Jurasza, 85-094, Bydgoszcz, Poland
| | - Dagmara Mirowska-Guzel
- Department of Clinical and Experimental Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, Banacha 1b, 02-097, Warsaw, Poland.
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Subramanian R, Ling J, Wang J, Wang K, Hao J, Jin H, Lai Y, Murray B, Wijaya S, Zhang H, Smith BJ. Human and nonclinical disposition of [ 14C]bictegravir, a potent integrase strand-transfer inhibitor for the treatment of HIV-1 infection. Xenobiotica 2022; 52:973-985. [PMID: 36546430 DOI: 10.1080/00498254.2022.2159569] [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: 12/24/2022]
Abstract
Bictegravir (BIC) is a potent small-molecule integrase strand-transfer inhibitor (INSTI) and a component of Biktarvy®, a single-tablet combination regimen that is currently approved for the treatment of human immunodeficiency virus type 1 (HIV-1) infection. The absorption, metabolism, distribution, and elimination (ADME) characteristics of BIC were determined through in vivo nonclinical and clinical studies (IND 121318).[14C]BIC was rapidly absorbed orally in mice, rats, monkeys and human. The cumulative dose recovery was high in nonclinical species (>80%) and humans (95.3%), with most of the excreted dose recovered in faeces. Quantifiable radioactivity with declining concentration was observed in rat tissues suggesting reversible binding. Unchanged BIC was the most abundant circulating component in all species along with two notable metabolites M20 (a sulphate conjugate of hydroxylated BIC) and M15 (a glucuronide conjugate of BIC). BIC was primarily eliminated by hepatic metabolism followed by excretion of the biotransformed products into faeces. In vitro drug-drug interaction (DDI) studies with M15 and M20 demonstrated that no clinically relevant interactions were expected.Overall, BIC is a novel and potent INSTI with a favourable resistance, PK, and ADME profile that provides important improvements over other currently available INSTIs for the treatment of HIV-1.
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Affiliation(s)
| | - John Ling
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | - Kelly Wang
- Gilead Sciences, Inc., Foster City, CA, USA
| | - Jia Hao
- Gilead Sciences, Inc., Foster City, CA, USA
| | - Haolun Jin
- Gilead Sciences, Inc., Foster City, CA, USA
| | - Yurong Lai
- Gilead Sciences, Inc., Foster City, CA, USA
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Gelé T, Chéret A, Castro Gordon A, Nkam L, Furlan V, Pallier C, Becker PH, Catalan P, Goujard C, Taburet AM, Gasnault J, Gouget H, Barrail-Tran A. Cerebrospinal fluid exposure to bictegravir/emtricitabine/tenofovir in HIV-1-infected patients with CNS impairment. J Antimicrob Chemother 2021; 76:3280-3285. [PMID: 34508640 DOI: 10.1093/jac/dkab334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/04/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The penetration of antiretroviral drugs into deep compartments, such as the CNS, is a crucial component of strategies towards an HIV cure. This study aimed to determine CSF concentrations of bictegravir, emtricitabine and tenofovir in patients with HIV-related CNS impairment (HCI) enrolled in a real-life observational study. METHODS Patients with HCI treated by optimized ART, including bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) for at least 1 month were enrolled. Plasma and CSF concentrations were measured by quality control-validated assays (LC-MS/MS). The inhibitory quotient (IQARV) was calculated as the ratio of unbound (bictegravir) or total (emtricitabine and tenofovir) concentration to half (or 90%) maximal inhibitory concentration for bictegravir (or emtricitabine and tenofovir). All numerical variables are expressed as median (range). RESULTS Twenty-four patients (nine women) were enrolled. The age was 45 (26-68) years. Unbound bictegravir and total emtricitabine and tenofovir CSF concentrations were 4.4 (1.6-9.6), 84.4 (28.6-337.4) and 1.6 (0.7-4.3) ng/mL, respectively. The unbound bictegravir CSF fraction was 34% (15%-82%) versus 0.33% (0.11%-0.92%) in plasma. Three patients had an IQARV above unity for the three antiretrovirals. Factors positively associated with the CSF concentration (unbound for bictegravir) were age and total plasma concentration for the three antiretrovirals. Patients aged over 51 years had higher CSF concentrations (unbound for bictegravir). CONCLUSIONS We observed low CSF exposure to bictegravir, emtricitabine and tenofovir. These results suggest that BIC/FTC/TAF should be used with caution as first-line treatment for people living with HIV with HCI under 51 years of age.
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Affiliation(s)
- Thibaut Gelé
- AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Service de Pharmacie Clinique, Le Kremlin-Bicêtre, France.,Université Paris-Saclay, Inserm, CEA, Immunologie des Maladies Virales, Auto-Immunes, Hématologiques et Bactériennes, 92265 Fontenay-aux-Roses, France
| | - Antoine Chéret
- AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, Le Kremlin-Bicêtre, France.,Inserm U1016, CNRS UMR 8104, Université Paris Descartes, Institut Cochin, Paris, France
| | - Alicia Castro Gordon
- AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, Le Kremlin-Bicêtre, France
| | - Lionelle Nkam
- AP-HP. Université Paris-Saclay, Hôpital Ambroise-Paré, Unité de Recherche Clinique, Boulogne-Billancourt, France
| | - Valérie Furlan
- AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Unité fonctionnelle de Pharmacologie, Le Kremlin-Bicêtre, France
| | - Coralie Pallier
- AP-HP. Université Paris-Saclay, Hôpital Paul-Brousse, Service de Virologie, Villejuif, France
| | - Pierre-Hadrien Becker
- AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Service de Biochimie, Le Kremlin-Bicêtre, France
| | - Pilartxo Catalan
- AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, Le Kremlin-Bicêtre, France
| | - Cécile Goujard
- AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, Le Kremlin-Bicêtre, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, 94807 Villejuif, France.,Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Anne-Marie Taburet
- Université Paris-Saclay, Inserm, CEA, Immunologie des Maladies Virales, Auto-Immunes, Hématologiques et Bactériennes, 92265 Fontenay-aux-Roses, France
| | - Jacques Gasnault
- Université Paris-Saclay, Inserm, CEA, Immunologie des Maladies Virales, Auto-Immunes, Hématologiques et Bactériennes, 92265 Fontenay-aux-Roses, France.,AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Service de Médecine Interne et Immunologie Clinique, Le Kremlin-Bicêtre, France
| | - Hélène Gouget
- Université Paris-Saclay, Inserm, CEA, Immunologie des Maladies Virales, Auto-Immunes, Hématologiques et Bactériennes, 92265 Fontenay-aux-Roses, France
| | - Aurélie Barrail-Tran
- AP-HP. Université Paris-Saclay, Hôpital Bicêtre, Service de Pharmacie Clinique, Le Kremlin-Bicêtre, France.,Université Paris-Saclay, Inserm, CEA, Immunologie des Maladies Virales, Auto-Immunes, Hématologiques et Bactériennes, 92265 Fontenay-aux-Roses, France.,Université Paris-Saclay, Faculté de Pharmacie, Châtenay-Malabry, France
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CNS Considerations in ART Simplification Strategies. Curr HIV/AIDS Rep 2021; 18:549-557. [PMID: 34739699 DOI: 10.1007/s11904-021-00580-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF THE REVIEW This review summarizes current knowledge on central nervous system (CNS) considerations in ART simplification strategies. RECENT FINDINGS Antiretroviral therapies (ART) showing efficacy in plasma will usually show efficacy in the cerebrospinal fluid (CSF). ART simplification may virologically fail if the new regimen has less than two active drugs, the genetic barrier of drugs is not high, and the patient may harbour archived resistance. Dual therapies including a boosted protease inhibitor (PI) or dolutegravir (DTG) are generally effective from the CNS perspective. In cases of related neurotoxicity, switching from either efavirenz (EFV) or DTG to another equally effective drug with better CNS tolerability usually leads to complete resolution of CNS symptoms. However, improvement may be incomplete when factors other than ART that cannot be easily modified are involved.
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7
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Imaz A, Tiraboschi JM, Niubó J, Martinez-Picado J, Cottrell ML, Domingo P, Chivite I, Negredo E, Schauer A, Van Horne B, Morenilla S, Urrea V, Silva-Klug A, Scévola S, Garcia B, Kashuba ADM, Podzamczer D. Dynamics of the Decay of Human Immunodeficiency Virus (HIV) RNA and Distribution of Bictegravir in the Genital Tract and Rectum in Antiretroviral-naive Adults Living With HIV-1 Treated With Bictegravir/Emtricitabine/Tenofovir Alafenamide (Spanish HIV/AIDS Research Network, PreEC/RIS 58). Clin Infect Dis 2021; 73:e1991-e1999. [PMID: 32945851 PMCID: PMC8492151 DOI: 10.1093/cid/ciaa1416] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The pharmacokinetics of bictegravir (BIC) and its association with the decay of human immunodeficiency virus (HIV)-1 RNA in genital fluids and the rectum have not yet been addressed. METHODS We conducted a prospective, multicenter study of antiretroviral-naive people living with HIV-1 and initiating BIC/emtricitabine (FTC)/tenofovir alafenamide (TAF). HIV-1 RNA was measured (limit of quantification, 40 copies/mL) in blood plasma (BP), seminal plasma (SP), rectal fluid (RF), and cervicovaginal fluid (CVF) at baseline; Days 3, 7, 14, and 28; and Weeks 12 and 24. Total and protein-unbound BIC concentrations at 24 hours postdose (C24h) were quantified in BP, SP, CVF and rectal tissue (RT) on Day 28 and Week 12 using a validated liquid chromatography-tandem mass spectrometry assay. RESULTS The study population comprised 15 males and 8 females. In SP, RF, and CVF, the baseline HIV-1 RNA was >40 copies/mL in 12/15, 13/15, and 4/8 individuals, respectively, with medians of 3.54 (2.41-3.79), 4.19 (2.98-4.70), and 2.56 (1.61-3.56) log10 copies/mL, respectively. The initial decay slope was significantly lower in SP than in RF and BP. The time to undetectable HIV-1 RNA was significantly shorter in SP and RF than in BP. All women achieved undetectable HIV-1 RNA in CVF at Day 14. The median total BIC concentrations in SP, RT, and CVF were 65.5 (20.1-923) ng/mL, 74.1 (6.0-478.5) ng/g, and 61.6 (14.4-1760.2) ng/mL, respectively, representing 2.7%, 2.6%, and 2.8% of the BP concentration, respectively, while the protein-unbound fractions were 51.1%, 44.6%, and 42.6%, respectively. CONCLUSIONS BIC/FTC/TAF led to rapid decay of HIV-1 RNA in genital and rectal fluids. Protein-unbound BIC concentrations in SP, RT, and CVF highly exceeded the half-maximal effective concentration (EC50) value (1.1 ng/mL). CLINICAL TRIALS REGISTRATION EudraCT 2018-002310-12.
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Affiliation(s)
- Arkaitz Imaz
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infection (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Juan M Tiraboschi
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infection (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Niubó
- Department of Microbiology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Javier Martinez-Picado
- IrsiCaixa AIDS Research Institute, Badalona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- University of Vic–Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Mackenzie L Cottrell
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Pere Domingo
- Department of Infectious Diseases, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Ivan Chivite
- Department of Internal Medicine, Sant Joan Despí Moisès Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | - Eugenia Negredo
- Lluita Contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
| | - Amanda Schauer
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian Van Horne
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sandra Morenilla
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infection (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Víctor Urrea
- IrsiCaixa AIDS Research Institute, Badalona, Spain
| | - Ana Silva-Klug
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infection (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Sofía Scévola
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infection (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Benito Garcia
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infection (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Angela D M Kashuba
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel Podzamczer
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infection (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
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8
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Tiraboschi J, Scévola S, Dilly Penchala S, Challenger E, Else L, Prieto P, Saumoy M, Imaz A, Silva-Klug A, Niubó J, Soriano I, Khoo S, Rigo-Bonin R, Podzamczer D. Doravirine Achieves Adequate CSF Exposure and is Mostly Unbound to Proteins. Clin Infect Dis 2021; 74:1855-1858. [PMID: 34549268 DOI: 10.1093/cid/ciab835] [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: 06/23/2021] [Indexed: 11/12/2022] Open
Abstract
We determined total and unbound concentrations of Doravirine (DOR) in cerebrospinal fluid (CSF) and blood plasma. Total and unbound DOR concentrations in CSF exceeded the EC50 value against wild-type virus (5.1 ng/mL) in all subjects suggesting that DOR may contribute to inhibit viral replication in this compartment.
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Affiliation(s)
- Juan Tiraboschi
- HIV and STI Unit. Infectious Disease Service. Hospital Universitari de Bellvitge-IDIBELL. Universitat de Barcelona. L'Hospitalet de Llobregat Barcelona, Spain
| | - Sofia Scévola
- HIV and STI Unit. Infectious Disease Service. Hospital Universitari de Bellvitge-IDIBELL. Universitat de Barcelona. L'Hospitalet de Llobregat Barcelona, Spain
| | - Sujan Dilly Penchala
- Department of Molecular and Clinical Pharmacology. University of Liverpool, Liverpool, UK
| | - Elisabeth Challenger
- Department of Molecular and Clinical Pharmacology. University of Liverpool, Liverpool, UK
| | - Laura Else
- Department of Molecular and Clinical Pharmacology. University of Liverpool, Liverpool, UK
| | - Paula Prieto
- HIV and STI Unit. Infectious Disease Service. Hospital Universitari de Bellvitge-IDIBELL. Universitat de Barcelona. L'Hospitalet de Llobregat Barcelona, Spain
| | - Maria Saumoy
- HIV and STI Unit. Infectious Disease Service. Hospital Universitari de Bellvitge-IDIBELL. Universitat de Barcelona. L'Hospitalet de Llobregat Barcelona, Spain
| | - Arkaitz Imaz
- HIV and STI Unit. Infectious Disease Service. Hospital Universitari de Bellvitge-IDIBELL. Universitat de Barcelona. L'Hospitalet de Llobregat Barcelona, Spain
| | - Ana Silva-Klug
- HIV and STI Unit. Infectious Disease Service. Hospital Universitari de Bellvitge-IDIBELL. Universitat de Barcelona. L'Hospitalet de Llobregat Barcelona, Spain
| | - Jordi Niubó
- Microbiology Service. Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat Barcelona, Spain
| | - Irene Soriano
- HIV and STI Unit. Infectious Disease Service. Hospital Universitari de Bellvitge-IDIBELL. Universitat de Barcelona. L'Hospitalet de Llobregat Barcelona, Spain
| | - Saye Khoo
- Department of Molecular and Clinical Pharmacology. University of Liverpool, Liverpool, UK
| | - Raul Rigo-Bonin
- Pharmacology Service, Bellvitge University Hospital, Barcelona, Spain
| | - Daniel Podzamczer
- HIV and STI Unit. Infectious Disease Service. Hospital Universitari de Bellvitge-IDIBELL. Universitat de Barcelona. L'Hospitalet de Llobregat Barcelona, Spain
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9
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Devanathan AS, Cottrell ML. Pharmacology of HIV Cure: Site of Action. Clin Pharmacol Ther 2021; 109:841-855. [PMID: 33540481 DOI: 10.1002/cpt.2187] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/08/2021] [Indexed: 12/14/2022]
Abstract
Despite significant advances in HIV treatment over the past 30 years, critical barriers to an HIV cure persist. The HIV reservoir, defined at both the cellular and anatomical level, constitutes the main barrier to cure. While the mechanisms underlying the reservoir are not yet well understood, one theory to explain persistence at the anatomical level is that subtherapeutic exposure to antiretroviral therapy (ART) within certain tissue compartments permits ongoing replication. Characterizing ART pharmacology throughout the body is important in the context of these potential pharmacologic sanctuaries and for maximizing the probability of success with forthcoming cure strategies that rely on latency reversal and require ART to prevent reseeding the reservoir. In this review, we provide a comprehensive overview of ART and latency reversal agent distribution at the site of action for HIV cure (i.e., anatomical sites commonly associated with HIV persistence, such as lymphoid organs and the central nervous system). We also discuss methodologic approaches that provide insight into HIV cure pharmacology, including experimental design and advances within the computational, pharmaceutical, and analytical chemistry fields. The information discussed in this review will assist in streamlining the development of investigational cure strategies by providing a roadmap to ensure therapeutic exposure within the site of action for HIV cure.
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Affiliation(s)
- Aaron S Devanathan
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Mackenzie L Cottrell
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
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10
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Characteristics of Dolutegravir and Bictegravir Plasma Protein Binding: a First Approach for the Study of Pharmacologic Sanctuaries. Antimicrob Agents Chemother 2020; 64:AAC.00895-20. [PMID: 32868324 DOI: 10.1128/aac.00895-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/25/2020] [Indexed: 01/01/2023] Open
Abstract
This study aimed to characterize in vitro dolutegravir (DTG) and bictegravir (BIC) binding. They had a preferential binding to human serum albumin (HSA) with two classes of albumin sites. Human alpha-1-acid glycoprotein (HAAG) binding of DTG and BIC showed an atypical nonlinear binding. The low-affinity site on HSA, the main plasma binding protein, suggests that the high protein binding rate should not impair passive diffusion.
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11
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Avedissian SN, Dyavar SR, Fox HS, Fletcher CV. Pharmacologic approaches to HIV-associated neurocognitive disorders. Curr Opin Pharmacol 2020; 54:102-108. [PMID: 33049585 DOI: 10.1016/j.coph.2020.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/04/2020] [Indexed: 11/17/2022]
Abstract
Antiretroviral therapy in people living with HIV can achieve potent, long-term suppression of HIV plasma viremia and has increased life expectancy. The central nervous system is infected early after virus acquisition and remains a reservoir for HIV. HIV-associated neurocognitive disorders (HAND) are an end-organ manifestation of HIV infection. The need to address neurological complications caused by HAND is significant as approximately 50% of people living with HIV on suppressive antiretroviral therapy are estimated to have some form of HAND. This review discusses the pathophysiology of HAND, CSF/CNS penetration and clinical pharmacology of antiretrovirals including pharmacokinetic/pharmacodynamic relationships, the persistence of HIV in the brain, and future therapeutic approaches to preserve and improve sustained viral suppression in the brain.
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Affiliation(s)
- Sean N Avedissian
- Antiviral Pharmacology Laboratory, UNMC Center for Drug Discovery, Omaha, NE, United States
| | - Shetty Ravi Dyavar
- Antiviral Pharmacology Laboratory, UNMC Center for Drug Discovery, Omaha, NE, United States
| | - Howard S Fox
- Center for Integrative and Translational Neuroscience, Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Courtney V Fletcher
- Antiviral Pharmacology Laboratory, UNMC Center for Drug Discovery, Omaha, NE, United States.
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12
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Tiraboschi JM, Rojas J, Zetterberg H, Blennow K, Niubo J, Gostner J, Navarro-Alcaraz A, Piatti C, Fuchs D, Gisslén M, Rigo-Bonnin R, Martinez E, Podzamczer D. No Changes in Human Immunodeficiency Virus (HIV) Suppression and Inflammatory Markers in Cerebrospinal Fluid in Patients Randomly Switched to Dolutegravir Plus Lamivudine (Spanish HIV/AIDS Research Network, PreEC/RIS 62). J Infect Dis 2020; 223:1928-1933. [PMID: 33049035 DOI: 10.1093/infdis/jiaa645] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/07/2020] [Indexed: 11/14/2022] Open
Abstract
A major concern of human immunodeficiency virus (HIV) dual therapy is a potentially lower efficacy in viral reservoirs, especially in the central nervous system (CNS). We evaluated HIV RNA, neuronal injury, and inflammatory biomarkers and dolutegravir (DTG) exposure in cerebrospinal fluid (CSF) in patients switching to DTG plus lamivudine (3TC). All participants maintained viral suppression in plasma and CSF at week 48. We observed no increase in CSF markers of inflammation or neuronal injury. Median (interquartile range) total and unbound DTG in CSF were 7.3 (5.9-8.4) and 1.7 (1.2-1.9) ng/mL, respectively. DTG+3TC may maintain viral control without changes in inflammatory/injury markers within the CNS reservoir.
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Affiliation(s)
- Juan M Tiraboschi
- Bellvitge University Hospital. Bellvitge Biomedical Research Institute. University of Barcelona, Barcelona, Spain
| | - Jhon Rojas
- Infectious Diseases Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,UK Dementia Research Institute at UCL, London, United Kingdom.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jordi Niubo
- Bellvitge University Hospital. Bellvitge Biomedical Research Institute. University of Barcelona, Barcelona, Spain
| | | | - Antonio Navarro-Alcaraz
- Bellvitge University Hospital. Bellvitge Biomedical Research Institute. University of Barcelona, Barcelona, Spain
| | - Camila Piatti
- Bellvitge University Hospital. Bellvitge Biomedical Research Institute. University of Barcelona, Barcelona, Spain
| | | | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Raul Rigo-Bonnin
- Pharmacology Service, Bellvitge University Hospital, Barcelona, Spain
| | - Esteban Martinez
- Infectious Diseases Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Daniel Podzamczer
- Bellvitge University Hospital. Bellvitge Biomedical Research Institute. University of Barcelona, Barcelona, Spain
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13
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Rigo-Bonnin R, Tiraboschi JM, Álvarez-Álvarez M, Pérez-Fernández GA, Sanjuás-Iglesias M, Scévola S, Niubó J, Videla S, Podzamczer D. Measurement of total and unbound bictegravir concentrations in plasma and cerebrospinal fluid by UHPLC-MS/MS. J Pharm Biomed Anal 2020; 185:113250. [PMID: 32199329 DOI: 10.1016/j.jpba.2020.113250] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 12/13/2022]
Abstract
Bictegravir is a novel integrase strand transfer inhibitor, administrated in co-formulation with tenofovir alafenamide and emtricitabine (Biktarvy®), indicated in the management of HIV-1 infection in patients not previously treated with antiretroviral therapy. Bictegravir is highly bound to plasma proteins, and this significantly determines its clearance, solubility, and activity. These characteristics are crucial determinants of bictegravir penetration into human body compartments, as the central nervous system. We developed and validated UHPLC-MS/MS procedures to measure total and unbound bictegravir concentrations in plasma and cerebrospinal fluid. Simple protein precipitation with acetonitrile was implemented to prepare plasma and cerebrospinal fluid samples. Sample preparation was preceded by ultrafiltration for measuring unbound bictegravir concentrations. Chromatographic separations were achieved on an Acquity® UHPLC® BEHTM (2.1 × 100 mm id, 1.7 μm) reverse-phase C18 column using an isocratic mobile phase 20:80 (v/v) water/acetonitrile with 0.1% formic. Bictegravir and its internal standard (bictegravir-15N d2) were detected by electrospray ionization mass spectrometry in positive and multiple reaction monitoring modes, using transitions of 450.2→289.2/145.4 and 453.2→289.2, respectively. Ultrafiltration procedures presented non-specific bindings of (8.6 ± 1.2) % for bictegravir in plasma and (26.6 ± 3.1) % for bictegravir in cerebrospinal fluid. Linearity was observed between (10.70-8560) μg/L, (1.07-856.0) μg/L for total and unbound bictegravir in plasma, and 0.107-26.75 μg/L for total and unbound bictegravir in cerebrospinal fluid. Imprecisions, absolute relative biases, normalized-matrix factors, and normalized-recoveries were ≤14.4%, ≤13.8%, (97.4-102.5) %, and (99.8-105.1) %, respectively. No significant interferences and carry-over were observed. The validated UHPLC-MS/MS procedures could be useful for pharmacokinetic and pharmacodynamic studies.
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Affiliation(s)
- Raúl Rigo-Bonnin
- Laboratori Clínic Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Juan Manuel Tiraboschi
- HIV and STI Unit, Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Álvarez-Álvarez
- Laboratori Clínic Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gloria Ainara Pérez-Fernández
- Laboratori Clínic Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mercedes Sanjuás-Iglesias
- Laboratori Clínic Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sofía Scévola
- HIV and STI Unit, Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Niubó
- Microbiology Department, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sebastián Videla
- Clinical Research Support Unit, Clinical Pharmacology Department, Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Daniel Podzamczer
- HIV and STI Unit, Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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