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The Nucleoside/Nucleotide Analogs Tenofovir and Emtricitabine Are Inactive against SARS-CoV-2. Molecules 2022; 27:molecules27134212. [PMID: 35807457 PMCID: PMC9267940 DOI: 10.3390/molecules27134212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/24/2022] Open
Abstract
The urgent response to the COVID-19 pandemic required accelerated evaluation of many approved drugs as potential antiviral agents against the causative pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Using cell-based, biochemical, and modeling approaches, we studied the approved HIV-1 nucleoside/tide reverse transcriptase inhibitors (NRTIs) tenofovir (TFV) and emtricitabine (FTC), as well as prodrugs tenofovir alafenamide (TAF) and tenofovir disoproxilfumarate (TDF) for their antiviral effect against SARS-CoV-2. A comprehensive set of in vitro data indicates that TFV, TAF, TDF, and FTC are inactive against SARS-CoV-2. None of the NRTIs showed antiviral activity in SARS-CoV-2 infected A549-hACE2 cells or in primary normal human lung bronchial epithelial (NHBE) cells at concentrations up to 50 µM TAF, TDF, FTC, or 500 µM TFV. These results are corroborated by the low incorporation efficiency of respective NTP analogs by the SARS-CoV-2 RNA-dependent-RNA polymerase (RdRp), and lack of the RdRp inhibition. Structural modeling further demonstrated poor fitting of these NRTI active metabolites at the SARS-CoV-2 RdRp active site. Our data indicate that the HIV-1 NRTIs are unlikely direct-antivirals against SARS-CoV-2, and clinicians and researchers should exercise caution when exploring ideas of using these and other NRTIs to treat or prevent COVID-19.
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Geretti AM, Stockdale AJ, Kelly SH, Cevik M, Collins S, Waters L, Villa G, Docherty A, Harrison EM, Turtle L, Openshaw PJM, Baillie JK, Sabin CA, Semple MG. Outcomes of Coronavirus Disease 2019 (COVID-19) Related Hospitalization Among People With Human Immunodeficiency Virus (HIV) in the ISARIC World Health Organization (WHO) Clinical Characterization Protocol (UK): A Prospective Observational Study. Clin Infect Dis 2021; 73:e2095-e2106. [PMID: 33095853 PMCID: PMC7665382 DOI: 10.1093/cid/ciaa1605] [Citation(s) in RCA: 189] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evidence is conflicting about how human immunodeficiency virus (HIV) modulates coronavirus disease 2019 (COVID-19). We compared the presentation characteristics and outcomes of adults with and without HIV who were hospitalized with COVID-19 at 207 centers across the United Kingdom and whose data were prospectively captured by the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) World Health Organization (WHO) Clinical Characterization Protocol (CCP) study. METHODS We used Kaplan-Meier methods and Cox regression to describe the association between HIV status and day-28 mortality, after separate adjustment for sex, ethnicity, age, hospital acquisition of COVID-19 (definite hospital acquisition excluded), presentation date, 10 individual comorbidities, and disease severity at presentation (as defined by hypoxia or oxygen therapy). RESULTS Among 47 592 patients, 122 (0.26%) had confirmed HIV infection, and 112/122 (91.8%) had a record of antiretroviral therapy. At presentation, HIV-positive people were younger (median 56 vs 74 years; P < .001) and had fewer comorbidities, more systemic symptoms and higher lymphocyte counts and C-reactive protein levels. The cumulative day-28 mortality was similar in the HIV-positive versus HIV-negative groups (26.7% vs. 32.1%; P = .16), but in those under 60 years of age HIV-positive status was associated with increased mortality (21.3% vs. 9.6%; P < .001 [log-rank test]). Mortality was higher among people with HIV after adjusting for age (adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.01-2.14; P = .05), and the association persisted after adjusting for the other variables (aHR 1.69; 95% CI 1.15-2.48; P = .008) and when restricting the analysis to people aged <60 years (aHR 2.87; 95% CI 1.70-4.84; P < .001). CONCLUSIONS HIV-positive status was associated with an increased risk of day-28 mortality among patients hospitalized for COVID-19.
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Affiliation(s)
- Anna Maria Geretti
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences; Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals National Health Service (NHS) Foundation Trust, member of Liverpool Health Partners, Liverpool, United Kingdom
| | - Alexander J Stockdale
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences; Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals National Health Service (NHS) Foundation Trust, member of Liverpool Health Partners, Liverpool, United Kingdom
| | - Sophie H Kelly
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences; Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals National Health Service (NHS) Foundation Trust, member of Liverpool Health Partners, Liverpool, United Kingdom
| | - Muge Cevik
- Division of Infection and Global Health Research, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | | | - Laura Waters
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, United Kingdom
- British HIV Association, London, United Kingdom
| | - Giovanni Villa
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Annemarie Docherty
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, United Kingdom
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Lance Turtle
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences; Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals National Health Service (NHS) Foundation Trust, member of Liverpool Health Partners, Liverpool, United Kingdom
| | - Peter J M Openshaw
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - J Kenneth Baillie
- Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, United Kingdom
- Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Caroline A Sabin
- University College London (UCL), London, United Kingdom
- NIHR HPRU in Blood Borne and Sexually Transmitted Infections at UCL, London, United Kingdom
| | - Malcolm G Semple
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences; Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Respiratory Medicine, Institute in The Park, University of Liverpool, Alder Hey Children’s Hospital, Liverpool, United Kingdom
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Kowalska JD, Kase K, Vassilenko A, Harxhi A, Lakatos B, Lukić GD, Verhaz A, Yancheva N, Dumitrescu F, Jilich D, Machala L, Skrzat-Klapaczyńska A, Matulionyte R. The characteristics of HIV-positive patients with mild/asymptomatic and moderate/severe course of COVID-19 disease-A report from Central and Eastern Europe. Int J Infect Dis 2020; 104:293-296. [PMID: 33326871 PMCID: PMC7834141 DOI: 10.1016/j.ijid.2020.12.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022] Open
Abstract
Background There is currently no evidence suggesting that COVID-19 takes a different course in HIV-positive patients on antiretroviral treatment compared to the general population. However, little is known about the relation between specific HIV-related factors and the severity of the COVID-19 disease. Methods We performed a retrospective analysis of cases collected through an on-line survey distributed by the Euroguidelines in Central and Eastern Europe Network Group. In statistical analyses characteristics of HIV-positive patients, asymptomatic/moderate and moderate/severe course were compared. Results In total 34 HIV-positive patients diagnosed with COVID-19 were reported by 12 countries (Estonia, Czech Republic, Lithuania, Albania, Belarus, Romania, Serbia, Bosnia and Herzegovina, Poland, Russia, Hungary, Bulgaria). Asymptomatic courses of COVID-19 were reported in four (12%) cases, 11 (32%) patients presented with mild disease not requiring hospitalization, moderate disease with respiratory and/or systemic symptoms was observed in 14 (41%) cases, and severe disease with respiratory failure was found in five (15%) patients. The HIV-related characteristics of patients with an asymptomatic/mild course of COVID-19 were comparable to those with a moderate/severe course of COVID-19, except for the use of non-nucleoside reverse transcriptase inhibitors (NNRTIs) in cART regimen (0.0% vs. 31.6% respectively, p = 0.0239). Conclusions In our analyses HIV viral suppression and immunological status were not associated with the course of COVID-19 disease. On the contrary the cART regimen could contribute to severity of SARS-CoV-2 infection. Large and prospective studies are necessary to further investigate this relationship.
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Affiliation(s)
- Justyna D Kowalska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Poland.
| | | | | | - Arjan Harxhi
- University Hospital Center of Tirana, Infectious Disease Service, Albania
| | - Botond Lakatos
- National Institute of Hematology and Infectious Diseases, South-Pest Central Hospital, National Center of HIV, Hungary
| | - Gordana Dragović Lukić
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Serbia
| | - Antonija Verhaz
- Clinic for Infectious Diseases, University Clinical Centre of the Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina; Department for Infectious Diseases, Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Nina Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Disease Sofia, Bulgaria
| | | | - David Jilich
- Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Na Bulovce Hospital, Czech Republic
| | - Ladislav Machala
- Department of Infectious Diseases, 3rd Faculty of Medicine, Charles University in Prague and Na BuLovce Hospital, Czech Republic
| | - Agata Skrzat-Klapaczyńska
- Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Poland
| | - Raimonda Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
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