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Martin AJ, Shackleford DM, Charman SA, Wagstaff KM, Porter CJH, Jans DA. Increased In Vivo Exposure of N-(4-Hydroxyphenyl) Retinamide (4-HPR) to Achieve Plasma Concentrations Effective against Dengue Virus. Pharmaceutics 2023; 15:1974. [PMID: 37514160 PMCID: PMC10384639 DOI: 10.3390/pharmaceutics15071974] [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: 06/13/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
N-(4-hydroxyphenyl) retinamide (4-HPR, or fenretinide) has promising in vitro and in vivo antiviral activity against a range of flaviviruses and an established safety record, but there are challenges to its clinical use. This study evaluated the in vivo exposure profile of a 4-HPR dosage regime previously shown to be effective in a mouse model of severe dengue virus (DENV) infection, comparing it to an existing formulation for human clinical use for other indications and developed/characterised self-emulsifying lipid-based formulations of 4-HPR to enhance 4-HPR in vivo exposure. Pharmacokinetic (PK) analysis comprising single-dose oral and IV plasma concentration-time profiles was performed in mice; equilibrium solubility testing of 4-HPR in a range of lipids, surfactants and cosolvents was used to inform formulation approaches, with lead formulation candidates digested in vitro to analyse solubilisation/precipitation prior to in vivo testing. PK analysis suggested that effective plasma concentrations could be achieved with the clinical formulation, while novel lipid-based formulations achieved > 3-fold improvement. Additionally, 4-HPR exposure was found to be limited by both solubility and first-pass intestinal elimination but could be improved through inhibition of cytochrome P450 (CYP) metabolism. Simulated exposure profiles suggest that a b.i.d dosage regime is likely to maintain 4-HPR above the minimum effective plasma concentration for anti-DENV activity using the clinical formulation, with new formulations/CYP inhibition viable options to increase exposure in the future.
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Affiliation(s)
- Alexander J Martin
- Nuclear Signalling Laboratory, Department Biochem. & Mol. Biol., Biomedicine Discovery Institute, Monash University, Clayton 3800, Victoria, Australia
| | - David M Shackleford
- Centre for Drug Candidate Optimisation, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville 3052, Victoria, Australia
| | - Susan A Charman
- Centre for Drug Candidate Optimisation, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville 3052, Victoria, Australia
| | - Kylie M Wagstaff
- Nuclear Signalling Laboratory, Department Biochem. & Mol. Biol., Biomedicine Discovery Institute, Monash University, Clayton 3800, Victoria, Australia
| | - Christopher J H Porter
- Drug Delivery Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville 3052, Victoria, Australia
| | - David A Jans
- Nuclear Signalling Laboratory, Department Biochem. & Mol. Biol., Biomedicine Discovery Institute, Monash University, Clayton 3800, Victoria, Australia
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Domingo P, Suarez-Lozano I, Gutierrez F, Estrada V, Knobel H, Palacios R, Antela A, Blanco JR, Fulladosa X. Predictive factors of renal impairment in HIV-infected patients on antiretroviral therapy: Results from the VACH longitudinal cohort study. Nefrologia 2019; 39:497-505. [PMID: 31027896 DOI: 10.1016/j.nefro.2019.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 11/23/2018] [Accepted: 01/14/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The use of combination antiretroviral therapy has led to dramatic improvements in the life expectancy of HIV-infected persons. As result, the HIV population is aging and increasingly facing illnesses typically seen in the elderly, such as chronic kidney disease (CKD). METHODS A retrospective longitudinal study was conducted using data from years 2010 and 2014 in all HIV-infected persons enrolled at the Spanish VACH cohort. We analyzed the prevalence and the predictive factors for developing CKD (estimated glomerular filtration rate, eGFR<60mL/min/1.73m2). RESULTS The CKD prevalence at baseline was 456/8968, 5.1% [4.6-5.6%]. Of 8512 HIV-positive individuals examined without CKD at baseline (73.7% male, median age 44 years-old), 2.15% developed CKD (eGFR<60mL/min/1.73m2). The odds ratios [95%CI] for the independent predictive factors identified were gender (male) 0.54 [0.39-0.75], age (per year) 1.08 [1.07-1.10], AIDS diagnosis 1.40 [1.03-1.91], protease inhibitor-based regimens 1.49 [1.10-2.02], hypertension 1.37 [0.94-1.99], diabetes 1.84 [1.33-2.55] and history of cardiovascular events 1.66 [0.96-2.86]. CONCLUSION The prevalence and risk factors for CKD and its progression are high in the VACH cohort. Thus, preventive measures such as control of hypertension, diabetes and obesity, as well as efforts for avoiding exposure to nephrotoxic drugs, including some antiretrovirals, are warranted in this aging HIV population.
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Affiliation(s)
- Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | | | - Félix Gutierrez
- Infectious Diseases Unit, Hospital Universitario de Elche, Alicante, Spain
| | - Vicente Estrada
- Infectious Diseases Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Hernando Knobel
- Infectious Diseases Unit, Hospital del Mar, Barcelona, Spain
| | - Rosario Palacios
- Infectious Diseases Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Antonio Antela
- Infectious Diseases Unit, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
| | | | - Xavier Fulladosa
- Nephrology Unit, Hospital Universitario de Bellvitge, Barcelona, Spain
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Ruzicka DJ, Imai K, Takahashi K, Naito T. Greater burden of chronic comorbidities and co-medications among people living with HIV versus people without HIV in Japan: A hospital claims database study. J Infect Chemother 2018; 25:89-95. [PMID: 30396821 DOI: 10.1016/j.jiac.2018.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/11/2018] [Accepted: 10/10/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study examined the prevalence of chronic comorbidities and the use of co-medications among people living with HIV (PLWH) on antiretrovirals in Japan, compared with age-matched controls without HIV. METHODS This was an observational, retrospective, cross-sectional study using a hospital claims database of Japanese hospitals with advanced medical capabilities (i.e., advanced treatment hospitals, general hospitals, acute care hospitals). We extracted data for PLWH aged ≥18 years with a prescription record of antiretrovirals between January 2010 and December 2015, and for age-, sex-, and hospital-matched people without HIV. For each group, chronic comorbidities (diabetes, hypertension, lipid disorders, vascular diseases, chronic kidney failure, cancers, psychiatric disorders, osteoporosis, and hepatitis B/C co-infection), and co-medications were examined by age group. RESULTS We analyzed data for 1445 PLWH and 14,450 people without HIV. The proportion of patients with multiple comorbidities was much greater among PLWH than controls of the same age group. Lipid disorders and diabetes were more prevalent in PLWH than controls (31.6% vs. 10.3% and 26.8% vs. 13.2%, respectively), both of which were more common in PLWH at earlier ages. Cancer was present in 8.1% of PLWH and 8.9% of controls. A greater proportion of PLWH used multiple co-medications other than antiretrovirals at earlier ages than controls. CONCLUSION PLWH taking antiretrovirals in Japan had a greater burden of comorbidities and co-medications with increasing age than people without HIV. In addition to appropriate management of comorbidities, medication reconciliation according to patients' co-medication profiles is important for successful management of this patient population.
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Affiliation(s)
- Daniel J Ruzicka
- MSD K.K., Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo, Japan.
| | - Kentaro Imai
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, USA
| | - Kenichi Takahashi
- MSD K.K., Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
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Volpe M, Uglietti A, Castagna A, Mussini C, Marchetti G, Bellagamba R, Bini T, Mancusi D, Termini R. Cardiovascular disease in women with HIV-1 infection. Int J Cardiol 2017; 241:50-56. [PMID: 28285796 DOI: 10.1016/j.ijcard.2017.02.117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 01/30/2017] [Accepted: 02/24/2017] [Indexed: 12/14/2022]
Abstract
Cardiovascular disease is a leading cause of death in women, nevertheless it is often underestimated in female patients without overt risk factors. The chronic infection by Human Immunodeficiency Virus (HIV) is clearly associated, along with the use of certain antiretroviral drugs and traditional risk factors, with an increased risk of cardiovascular diseases. The aim of this manuscript is to review the epidemiology, risk factors, pathogenesis, diagnostic approach, primary and secondary prevention strategies of cardiovascular disease in HIV-negative and HIV-positive female subjects. The ultimate goal is to promote knowledge and development of specific and appropriate clinical interventions and guidelines in this group of high-risk patients, mostly in view of the expected growth of ageing females with HIV.
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Affiliation(s)
- Massimo Volpe
- Cardiology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, University of Rome Sapienza, Italy; IRCCS Neuromed, IS, Italy.
| | | | | | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Marchetti
- Department of Health Sciences, Clinic of Infectious Diseases, University of Milan, ASST Santi Paolo and Carlo, Milan, Italy
| | | | - Teresa Bini
- Department of Health Sciences, Clinic of Infectious Diseases, University of Milan, ASST Santi Paolo and Carlo, Milan, Italy
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Desai KR, Chewning B, Wilcox A, Safdar N. Mail-order pharmacy experience of veterans living with AIDS/HIV. Res Social Adm Pharm 2017; 14:153-161. [PMID: 28291673 DOI: 10.1016/j.sapharm.2017.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The VA system is the largest single provider of healthcare in the United States and to individuals infected with HIV specifically. High quality medication management is particularly important since HIV is a chronic infectious condition which requires taking multiple medications with strict requirements for adherence to medication regimens. Veterans Administration (VA) patients are required to obtain all chronic medications using the VA mail-order pharmacy system. OBJECTIVE Drawing on Donabedian's Quality Improvement framework, this study sought to examine experiences that Veterans with HIV have with the Veterans Administration medication mail-order system, and to explore opportunities for quality improvement. METHODS A sequential, explanatory mixed-methods design was used to interview Veterans receiving care at a Midwestern Veterans Administration Hospital using a mail-order experience survey followed by in-depth interviews. All 57 Veterans, out of 72, who were successfully contacted consented to participate. RESULTS Overall, Veterans evaluated the mail-order service positively and valued the accuracy (correct medication delivery). However, a notable problem emerged with respect to assuring access to HIV medications with about half (47%) indicating running out of HIV medication. Respondents identified structural issues with respect to days covered by mailed medications (90 versus current 30 days) and process issues with scheduling new refills. Veterans also indicated the information sheets were too long, complex and not helpful for their queries. Patients were open to pharmacists playing an active role during clinic visits and felt this would help manage their conditions better. CONCLUSIONS Veterans generally reported that the VA Mail-order service was of high quality. However, some findings indicate there are opportunities to improve this service to be more patient-centered particularly for vulnerable HIV patients.
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Affiliation(s)
- Karishma Rohanraj Desai
- Surgical Health Services Research Unit, Department of Surgery, 1070 Arastradero Rd, Palo Alto, CA 94304, USA.
| | - Betty Chewning
- School of Pharmacy, University of Wisconsin, 777 Highland Ave., Madison, WI 53705, USA
| | - Andrew Wilcox
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Nasia Safdar
- ACOS for R&D, Research Service/HSR&D QUERI, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
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Hentzien M, Dramé M, Allavena C, Jacomet C, Valantin MA, Cabié A, Cuzin L, Rey D, Pugliese P, Bani-Sadr F. Impact of Age-related Comorbidities on Five-year Overall Mortality among Elderly HIV-Infected Patients in the Late HAART Era--Role of Chronic Renal Disease. J Nutr Health Aging 2016; 20:408-14. [PMID: 26999241 DOI: 10.1007/s12603-015-0608-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To identify main prognostic factors for 5-year mortality among age-related comorbidities (ARCs) in older people living with HIV (PLHIV). DESIGN A prospective, multicentre cohort study with a 5-year follow-up period in the late HAART era (from January 2008 to December 2012). SETTING The Dat'AIDS cohort involving 12 French hospitals. PARTICIPANTS All actively followed HIV-1 infected patients aged 60 or older. MEASUREMENTS The study endpoint was all-cause five-year mortality. The following ARCs were considered: chronic renal disease, cardiovascular diseases, cancer, chronic pulmonary disease, cirrhosis, diabetes and nutritional status. Hepatitis C (HCV), hepatitis B (HBV) co-infection and sociodemographic characteristics were also evaluated. Cox's Proportional Hazards model was used for multivariate analysis. RESULTS Among 1415 PLHIV aged 60 or more patients included, mean age was 66±5.5 years; 154 died (mortality rate 2.47/100 patient-years). The most prevalent ARCs were chronic renal disease (20.1%), diabetes (14.2%) and cardiovascular diseases (12.2%). By multivariate analysis, chronic renal disease (adjusted hazard ratio (aHR)=2.25; 95% confidence interval (CI) [1.58-2.21]; p<10-4), cardiovascular diseases (aHR=2.40; 95%CI[1.64-3.52]; p<10-4), non-HIV related cancer (aHR=1.91; 95%CI[1.20-3.05]; p=0.007), cirrhosis (aHR=2.99; 95%CI[1.68-5.33]; p<10-3), HCV co-infection (aHR=2.00; 95%CI[1.18-3.38]; p=0.009), low body mass index (aHR=2.42; 95%CI[1.46-4.01]; p<10-3) and CD4 cell count < 200 cells/µl (aHR=2.23; 95%CI[1.36-3.65]; p=0.002) were independently associated with 5 year mortality. CONCLUSION Due to a high prevalence, chronic renal disease and cardiovascular disease are main prognostic factors for 5-year mortality among aged PLHIV.
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Affiliation(s)
- M Hentzien
- Maxime Hentzien, Service de médecine interne, maladies infectieuses, immunologie Clinique, CHU Robert Debré, Avenue du général Koenig, 51092 Reims, France, Telephone number: (+33) 3 26 78 71 89, Fax number: (+33) 3 26 78 40 90, E-mail address:
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Werfalli M, Engel ME, Musekiwa A, Kengne AP, Levitt NS. The prevalence of type 2 diabetes among older people in Africa: a systematic review. Lancet Diabetes Endocrinol 2016; 4:72-84. [PMID: 26548379 DOI: 10.1016/s2213-8587(15)00363-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 09/07/2015] [Accepted: 09/11/2015] [Indexed: 12/18/2022]
Abstract
Little information is available on the prevalence of diabetes in people aged 55 years or older living on the African continent. We did a systematic review of the prevalence of type 2 diabetes in studies reported from Jan 1, 2000, to June 30, 2015, to provide accurate data for monitoring future trends. We did a comprehensive literature search using an African search filter and extracted and synthesised data from full papers. Among 1473 identified citations, 41 studies providing 49 separate data contributions involving 16 086 individuals met the inclusion criteria. The overall prevalence of diabetes was 13·7% (95% CI 11·3-16·3) and was higher in studies based on the oral glucose tolerance test (23·9%, 17·7-30·7, 12 contributions with 3415 participants) than fasting blood glucose criteria (10·9%, 8·9-13·0, 37 contributions with 12 671 participants; p<0·001). Prevalence was also higher in non-STEPS than in STEPS studies (17·1%, 95% CI 13·6-20·9) vs 9·6%, 6·6-13·0, p=0·003) and in urban than in rural settings (19·7%, 15·0-24·9 vs 7·9%, 4·6-12·0, p=0·0002), but did not differ significantly across age groups, sex, sample size, year of publication, region, or population coverage. These data highlight the need to reduce diabetes risk factors and implement adequate management strategies. In addition, they suggest that uniform diagnostic methods should be used across African countries and elsewhere to enable assessment of trends in diabetes prevalence and the success of diabetes prevention strategies. A collaborative initiative is required between key international and national diabetes and geriatric organisations to improve diabetes care for the older population in Africa and worldwide.
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Affiliation(s)
- Mahmoud Werfalli
- Chronic Disease Initiative for Africa (CDIA), University of Cape Town, Cape Town, South Africa; Division of Diabetic Medicine and Endocrinology, University of Cape Town, Cape Town, South Africa
| | - Mark E Engel
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Alfred Musekiwa
- Faculty of Medicine and Health Sciences, Centre for Evidence Based Health Care, Stellenbosch University, Cape Town, South Africa
| | - Andre P Kengne
- Non-Communicable Diseases Research Unit, University of Cape Town, Cape Town, South Africa
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa (CDIA), University of Cape Town, Cape Town, South Africa; Division of Diabetic Medicine and Endocrinology, University of Cape Town, Cape Town, South Africa.
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Cardiovascular disease risk in an aging HIV population: not just a question of biology. Curr Opin HIV AIDS 2015; 9:346-54. [PMID: 24824885 DOI: 10.1097/coh.0000000000000065] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW The objective of this review is to appraise recently published literature that describes the relationship between HIV, biologic and environmental risk factors, and cardiovascular disease (CVD) risk with particular emphasis on the aging HIV population and to demonstrate that these biologic and environmental factors may interact to increase the risk of CVD in the HIV population. RECENT FINDINGS The mechanisms linking HIV and CVD are multifactorial and encompass biological and 'environmental' modalities including multimorbid conditions that co-occur with HIV, immunologic alterations associated with HIV, polypharmacy (which affects adherence and increases likelihood of adverse drug-drug interactions) and healthcare disparities in CVD risk reduction by HIV status. SUMMARY Data regarding optimal treatment strategies that balance immunological restoration and CVD risk reduction are needed.
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Abstract
Introduction Cardiovascular disease (CVD) is a significant cause of non-AIDS-related morbidity and mortality in HIV-positive individuals [1]. Management of CVD and associated risk factors in HIV are complicated by drug interactions [2]. Optimal management can require specialist input. A previous cohort review highlighted CVD, comorbidity and cardiovascular (CV) risk in our patients [3]. In response, a combined HIV and cardiovascular monthly clinic was established: an HIV consultant works in real time with a cardiologist. The clinic manages CV disease, complex CV co-morbidities e.g. refractory hypertension, hyperlipidaemia, and assesses primary prevention. A dietician works alongside the clinic. Aims Describe the clinic caseload; record clinic interventions and outcomes; recommend service development. Materials and Methods We conducted a retrospective notes review of patients attending the co-morbidity clinic from January 2012 to May 2014. Data collected: demographic, HIV, CVD, CV risk, investigations and clinical interventions. Results From a cohort of approximately 960 patients (70% African), 60 (6%) were seen in the co-morbidity clinic over the specified time period. Median age was 53 (range 24-80). Although 60% of our cohort is female, 43% (26/60) of the CVD clinic were female. 42 (70%) were African. The mean CD4 was 560 (range 48-1339). All patients were on ART and 6 (10%) had a detectable viral load > 400 copies/mL. Clinic caseload: i) CVD: 9 had a prior CV event (ACS or CVA); 5 had CCF; new diagnoses included LVH (2), cardiac dysfunction (6); AF (2); atrial thrombus (1). ii) Co-morbidities: 48(80%) had hypertension – 10 (16.6%) were on quadruple therapy; 17 (28%) had diabetes; 35 (58%) were on a statin. Three had their smoking status clearly documented. Seventeen (28%) were referred to the dietician. Investigations included echo, 24-hour BP/ tape, CT angio, cardiac MR. Conclusions The joint clinic facilitated real-time decision making on clinical interventions. Patient access to cardiac investigations was expedited. Patients attended fewer outpatient appointments. Both cardiology and HIV clinicians preferred the benefits of joint working. Clinical outcomes were difficult to assess and will need further definition. Recommendations for development include: improved CV risk assessment, improved outcome measures, links to smoking cessation services.
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International Congress of Drug Therapy in HIV Infection 2-6 November 2014, Glasgow, UK. J Int AIDS Soc 2014. [DOI: 10.7448/ias.17.4.19856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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