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Stein J, Storcksdieck Genannt Bonsmann M, Streeck H. Barriers to HIV Cure. HLA 2018; 88:155-63. [PMID: 27620852 DOI: 10.1111/tan.12867] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023]
Abstract
Since the beginning of the epidemic, more than 70 million people have been infected with human immunodeficiency virus (HIV) and about 38 million have died from acquired immune deficiency syndrome (AIDS)-related illnesses. While the discovery of highly active antiretroviral therapy (HAART) in the mid 90's has saved millions of lives, a complete eradication of HIV is still not possible as HIV can persist for decades in a small reservoir of latently infected cells. Once reactivated, these latently infected cells can actively produce viral particles. Recent studies suggest that several sanctuaries exist within infected individuals where HIV can remain undetected by the immune system. These cellular, anatomical and microanatomical viral reservoirs represent a major obstacle for the eradication of HIV. Here we review recent findings on potential sanctuaries of HIV and address potential avenues to overcome these immunological barriers.
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Affiliation(s)
- J Stein
- Institute for HIV Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
| | | | - H Streeck
- Institute for HIV Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,US Military HIV Research Program, Henry M. Jackson Foundation, Rockville, MD, USA
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2
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Houzet L, Matusali G, Dejucq-Rainsford N. Origins of HIV-infected leukocytes and virions in semen. J Infect Dis 2015; 210 Suppl 3:S622-30. [PMID: 25414416 DOI: 10.1093/infdis/jiu328] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Although semen is the principal vector of human immunodeficiency virus (HIV) dissemination worldwide, the origin of the infected leukocytes and free viral particles in this body fluid remain elusive. Here we review the accumulated evidence of the genital origin of HIV in semen from therapy naive individuals and men receiving suppressive highly active antiretroviral therapy (HAART), summarize the data on the detection and localization of HIV/SIV within the male genital tract, discuss the potential involvement of each genital tissue as a source of infected cells and virions in semen in the absence and presence of HAART, and suggest further studies. Deciphering the exact sources of HIV in semen will be crucial to improving HIV transmission prevention strategies.
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Affiliation(s)
- Laurent Houzet
- Institut National de la Santé et de la Recherche Médicale, U1085-Institut de Recherche en Santé, Environnement et Travail, Université de Rennes 1, Structure Fédérative Recherche Biosit, Rennes, France
| | - Giulia Matusali
- Institut National de la Santé et de la Recherche Médicale, U1085-Institut de Recherche en Santé, Environnement et Travail, Université de Rennes 1, Structure Fédérative Recherche Biosit, Rennes, France
| | - Nathalie Dejucq-Rainsford
- Institut National de la Santé et de la Recherche Médicale, U1085-Institut de Recherche en Santé, Environnement et Travail, Université de Rennes 1, Structure Fédérative Recherche Biosit, Rennes, France
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3
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Trezza CR, Kashuba ADM. Pharmacokinetics of antiretrovirals in genital secretions and anatomic sites of HIV transmission: implications for HIV prevention. Clin Pharmacokinet 2014; 53:611-24. [PMID: 24859035 PMCID: PMC4094112 DOI: 10.1007/s40262-014-0148-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The incidence of HIV remains alarmingly high in many parts of the world. Prophylactic use of antiretrovirals, capable of concentrating in the anatomical sites of transmission, may reduce the risk of infection after an unprotected sexual exposure. To date, orally and topically administered antiretrovirals have exhibited variable success in preventing HIV transmission in large-scale clinical trials. Antiretroviral mucosal pharmacokinetics may help explain the outcomes of these investigations. Penetration and accumulation of antiretrovirals into sites of transmission can influence dosing strategies and pre-exposure prophylaxis clinical trial design. Antiretroviral tissue distribution varies widely within and between drug classes, attributed in part to their physicochemical properties and tissue-specific drug transporter expression. Nucleoside(-tide) reverse transcriptase inhibitors, the CCR5 antagonist maraviroc, and the integrase inhibitor raltegravir demonstrate the highest penetration into the male and female reproductive tracts and colorectal tissue relative to blood. This review describes antiretroviral exposure in anatomic sites of transmission, and places these findings in context with the prevention of HIV and the efficacy of pre-exposure prophylactic strategies.
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Affiliation(s)
- Christine R. Trezza
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC
| | - Angela D. M. Kashuba
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC
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4
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Abstract
Research in the many areas of HIV treatment, eradication and prevention has necessitated measurement of antiretroviral (ARV) concentrations in nontraditional specimen types. To determine the knowledgebase of critical details for accurate bioanalysis, a review of the literature was performed and summarized. Bioanalytical assays for 31 ARVs, including metabolites, were identified in 205 publications measuring various tissues and biofluids. 18 and 30% of tissue or biofluid methods, respectively, analyzed more than one specimen type; 35-37% of the tissue or biofluid methods quantitated more than one ARV. 20 and 76% of tissue or biofluid methods, respectively, were used for the analysis of human specimens. HPLC methods with UV detection predominated, but chronologically MS detection began to surpass. 40% of the assays provided complete intra- and inter-assay validation data, but only 9% of publications provided any stability data with even less for the prevalent ARV in treatments.
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5
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Klein DM, Evans KK, Hardwick RN, Dantzler WH, Wright SH, Cherrington NJ. Basolateral uptake of nucleosides by Sertoli cells is mediated primarily by equilibrative nucleoside transporter 1. J Pharmacol Exp Ther 2013; 346:121-9. [PMID: 23639800 DOI: 10.1124/jpet.113.203265] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The blood-testis barrier (BTB) prevents the entry of many xenobiotic compounds into seminiferous tubules thereby protecting developing germ cells. Understanding drug transport across the BTB may improve drug delivery into the testis. Members of one class of drug, nucleoside reverse transcriptase inhibitors (NRTIs), do penetrate the BTB, presumably through interaction with physiologic nucleoside transporters. By investigating the mechanism of nucleoside transport, it may be possible to design other drugs to bypass the BTB in a similar manner. We present a novel ex vivo technique to study transport at the BTB that employs isolated, intact seminiferous tubules. Using this system, we found that over 80% of total uptake by seminiferous tubules of the model nucleoside uridine could be inhibited by 100 nM nitrobenzylmercaptopurine riboside (NBMPR, 6-S-[(4-nitrophenyl)methyl]-6-thioinosine), a concentration that selectively inhibits equilibrative nucleoside transporter 1 (ENT1) activity. In primary cultured rat Sertoli cells, 100 nM NBMPR inhibited all transepithelial transport and basolateral uptake of uridine. Immunohistochemical staining showed ENT1 to be located on the basolateral membrane of human and rat Sertoli cells, whereas ENT2 was located on the apical membrane of Sertoli cells. Transepithelial transport of uridine by rat Sertoli cells was partially inhibited by the NRTIs zidovudine, didanosine, and tenofovir disoproxil fumarate, consistent with an interaction between these drugs and ENT transporters. These data indicate that ENT1 is the primary route for basolateral nucleoside uptake into Sertoli cells and a possible mechanism for nucleosides and nucleoside-based drugs to undergo transepithelial transport.
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Affiliation(s)
- David M Klein
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, Arizona, USA
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6
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Else LJ, Taylor S, Back DJ, Khoo SH. Pharmacokinetics of antiretroviral drugs in anatomical sanctuary sites: the male and female genital tract. Antivir Ther 2012; 16:1149-67. [PMID: 22155899 DOI: 10.3851/imp1919] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
HIV resides within anatomical 'sanctuary sites', where local drug exposure and viral dynamics may differ significantly from the systemic compartment. Suboptimal antiretroviral concentrations in the genital tract may result in compartmentalized viral replication, selection of resistant mutations and possible re-entry of wild-type/resistant virus into the systemic circulation. Therefore, achieving adequate antiretroviral exposure in the genital tract has implications for the prevention of sexual and vertical transmission of HIV. Penetration of antiretrovirals in the genital tract is expressed by accumulation ratios derived from the measurement of drug concentrations in time-matched seminal plasma/cervicovaginal fluid and plasma samples. Penetration varies by gender and may be drug (as opposed to class) specific with high interindividual variability. Concentrations in seminal plasma are highest for nucleoside analogues and lowest for protease inhibitors and efavirenz. Seminal accumulation of newer agents, raltegravir and maraviroc, is moderate (rank order of accumulation is nucleoside/nucleotide reverse transcriptase inhibitors [lamivudine/zidovudine/tenofovir/didanosine > stavudine/abacavir] > raltegravir > indinavir/maraviroc/nevirapine >> efavirenz/protease inhibitors [amprenavir/atazanavir/darunavir > lopinavir/ritonavir > saquinavir] > enfuvirtide). In the female genital tract, the nucleoside analogues exhibit high accumulation ratios, whereas protease inhibitors have limited penetration; however, substantial variability exists between individuals and study centres. Second generation non-nucleoside reverse transcriptase inhibitor etravirine, and maraviroc and raltegravir, demonstrate effective accumulation in cervicovaginal secretions (rank order of accumulation is nucleoside/nucleotide reverse transcriptase inhibitor [zidovudine/lamivudine/didanosine > emtricitabine/tenofovir] > indinavir > maraviroc/raltegravir/darunavir/etravirine > nevirapine/abacavir > protease inhibitors [amprenavir/atazanavir/ritonavir] > lopinavir/stavudine/efavirenz > saquinavir).
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Affiliation(s)
- Laura J Else
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK.
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7
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Nageswara Rao R, Ramachandra B, Mastan Vali R. Reversed-phase liquid chromatographic separation of antiretroviral drugs on a monolithic column using ionic liquids as mobile phase additives. J Sep Sci 2011; 34:500-7. [DOI: 10.1002/jssc.201000723] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/08/2010] [Accepted: 12/11/2010] [Indexed: 01/07/2023]
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Antiretroviral drug concentrations in the male and female genital tract: implications for the sexual transmission of HIV. Curr Opin HIV AIDS 2010; 5:335-43. [PMID: 20543610 DOI: 10.1097/coh.0b013e32833a0b69] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW To summarize the recent literature (2008-2010) on antiretroviral (ARV) drug disposition into the male and female genital tract. RECENT FINDINGS Recent studies have confirmed that penetration of antiretroviral agents into the male and female genital tracts are both drug and sex specific. Concentrations achieved vary considerably depending on the class of drug studied, the sampling techniques used and the times samples are obtained. SUMMARY There appear to be several patterns of drug penetration into the male and female genital tract. In addition there appear to be different patterns of genital shedding under the influence of antiretroviral therapy. What effect these factors will have on the sexual transmission of HIV or the evolution and transmission of resistant HIV remains to be seen.
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Pasquier C, Sauné K, Raymond S, Moinard N, Daudin M, Bujan L, Izopet J. Determining seminal plasma human immunodeficiency virus type 1 load in the context of efficient highly active antiretroviral therapy. J Clin Microbiol 2009; 47:2883-7. [PMID: 19641060 PMCID: PMC2738122 DOI: 10.1128/jcm.02131-08] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 04/20/2009] [Accepted: 07/20/2009] [Indexed: 11/20/2022] Open
Abstract
The semen plasma virus load is measured to ensure the safety of sperm processing during medically assisted procreation (MAP) for couples with a human immunodeficiency virus type 1 (HIV-1)-infected man. A practical, automated protocol using the COBAS Ampliprep CAP/CTM kit in the COBAS TaqMan96 system was developed to measure the HIV-1 load in semen plasma samples. HIV-1 was detected in 13.4% of the semen samples processed at our MAP center. Of the eight patients having a detectable semen HIV-1 load, five had no detectable virus in their blood plasma. This highlights the residual risk of HIV-1 transmission during unprotected intercourse and raises the question of the possible consequences of ineffective highly active antiretroviral therapy in the genital tract.
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Affiliation(s)
- Christophe Pasquier
- Service de Virologie, CHU de Toulouse, Institut Fédératif de Biologie, TSA40031, 330 avenue de Grande Bretagne, Toulouse F-31059, France.
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10
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Stekler J, Sycks BJ, Holte S, Maenza J, Stevens CE, Dragavon J, Collier AC, Coombs RW. HIV dynamics in seminal plasma during primary HIV infection. AIDS Res Hum Retroviruses 2008; 24:1269-74. [PMID: 18844461 DOI: 10.1089/aid.2008.0014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV dynamics in seminal plasma during primary HIV infection was evaluated through an observational study of individuals with primary HIV infection at the University of Washington Primary Infection Clinic. Seminal plasma HIV RNA was quantified using a real-time reverse transcription PCR assay. Blood plasma RNA was quantified by bDNA or PCR-based assays. Longitudinal analyses of HIV RNA levels over time used random effects regression analysis. From 1993 to 2005, 110 men collected 327 semen specimens. Initial blood and seminal plasma RNA levels in untreated men were only moderately correlated (Spearman r = 0.38, p = 0.0002). Estimated peak and set point levels were lower in semen than blood by 0.8 (p = 0.001) and 0.7 (p < 0.001) log(10) copies/ml, respectively. RNA decay rates were similar in the two compartments (p = 0.4). For 2 months after infection, mean HIV RNA levels in seminal plasma remained above a threshold level (3.8 log(10) copies/ml) that has been associated with recovery of infectious virus in vitro. HIV-positive men are likely to be most infectious in the first months following HIV acquisition. However, the modest relationship between HIV RNA levels in blood and seminal plasma suggests that the relative risk of HIV transmission during primary infection may vary from current estimates that are solely based on blood levels. Incorporating seminal plasma HIV levels into future mathematical models may increase the accuracy of these models.
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Affiliation(s)
- Joanne Stekler
- Department of Medicine, University of Washington, Seattle, Washington 98104
- Center for AIDS and STD, University of Washington, Seattle, Washington 98104
| | - Brian J. Sycks
- Department of Laboratory Medicine, University of Washington, Seattle, Washington 98104
| | - Sarah Holte
- Department of Medicine, University of Washington, Seattle, Washington 98104
- Center for AIDS and STD, University of Washington, Seattle, Washington 98104
- Fred Hutchinson Cancer Research Center, Seattle, Washington 98109
| | - Janine Maenza
- Department of Medicine, University of Washington, Seattle, Washington 98104
| | - Claire E. Stevens
- Department of Medicine, University of Washington, Seattle, Washington 98104
| | - Joan Dragavon
- Department of Laboratory Medicine, University of Washington, Seattle, Washington 98104
| | - Ann C. Collier
- Department of Medicine, University of Washington, Seattle, Washington 98104
- Center for AIDS and STD, University of Washington, Seattle, Washington 98104
| | - Robert W. Coombs
- Department of Medicine, University of Washington, Seattle, Washington 98104
- Center for AIDS and STD, University of Washington, Seattle, Washington 98104
- Department of Laboratory Medicine, University of Washington, Seattle, Washington 98104
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11
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Choi L, Caffo B, Rohde C, Ndovi TT, Hendrix CW. A mechanistic latent variable model for estimating drug concentrations in the male genital tract: a case study in drug kinetics. Stat Med 2008; 27:2697-714. [PMID: 17948921 DOI: 10.1002/sim.3097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study is to develop statistical methodology to facilitate indirect estimation of the concentration of antiretroviral drugs and viral loads in the prostate gland and the seminal vesicle. The differences in antiretroviral drug concentrations in these organs may lead to suboptimal concentrations in one gland. Suboptimal levels of the antiretroviral drugs may not be able to fully suppress the virus in that gland, leading to a source of sexually transmissible virus and increasing the chance of selecting for a drug-resistant virus. This information may be useful for selecting an antiretroviral drug regimen that will achieve optimal concentrations in the genital tract glands. Using fractionally collected semen ejaculates, Lundquist (Acta Physiol. Scand. 1949; 19:1-95) measured levels of surrogate markers in each fraction that are uniquely produced by specific male accessory glands. To determine the original glandular concentrations of the surrogate markers, Lundquist solved a simultaneous series of linear equations. This method has several limitations. In particular, it does not yield a unique solution, it does not address measurement error, and it does not provide population-averaged estimates after taking into account inter-subject variability in the parameters. To cope with these limitations, we developed a mechanistic latent variable model based on the physiology of the male genital tract and surrogate markers. We employ a Bayesian approach and perform a sensitivity analysis on the distributional assumptions on the random effects and priors. The model and Bayesian approach are validated on experimental data where the concentration of a drug should be (biologically) differentially distributed between the two glands. In this example, the Bayesian model-based conclusions are found to be robust to model specification and this hierarchical approach leads to more scientifically valid conclusions than the original methodology. In particular, unlike existing methods, the proposed model-based approach was not affected by a common form of outliers.
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Affiliation(s)
- Leena Choi
- Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville, TN 37232-2158, USA.
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12
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Chan DJ, Ray JE. Quantification of antiretroviral drugs for HIV-1 in the male genital tract: current data, limitations and implications for laboratory analysis. J Pharm Pharmacol 2008; 59:1451-62. [PMID: 17976255 DOI: 10.1211/jpp.59.11.0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Antiretroviral therapy has reduced the morbidity and mortality associated with HIV-1/AIDS in developed countries. Viral replication in blood plasma is suppressed by antiretroviral drugs, whereas virus in the male genital tract is genetically and phenotypically unique and may not be suppressed. This viral compartmentalization affects antiretroviral drug penetration of the male genital tract and capacity for antiretroviral therapy to reduce sexual transmission. The problem of having two distinct viral populations within any given individual is compounded by the fact that antiretroviral drugs penetrate semen to varying degrees. Incomplete suppression of genital tract virus may yield drug-resistant virus and increase the risk of sexual transmission. This review critically appraises current studies of antiretroviral drug quantification in semen and suggests recommendations to address observed limitations.
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Affiliation(s)
- Derek J Chan
- Division of Sexual Health, Albion Street Centre, Sydney, Australia.
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13
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Cao YJ, Hendrix CW. Male genital tract pharmacology: developments in quantitative methods to better understand a complex peripheral compartment. Clin Pharmacol Ther 2007; 83:401-12. [PMID: 17786163 DOI: 10.1038/sj.clpt.6100342] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A substantial health burden results from medical problems affecting the male genital tract, including chronic morbidity conditions affecting a large proportion of men, such as benign prostatic hypertrophy and prostatitis, and potentially lethal conditions, such as prostate cancer and human immunodeficiency virus transmission. Rational approaches to therapeutics in these conditions should benefit from understanding local pharmacokinetics and pharmacodynamics of active drugs within the male genital tract. However, the description of drug distribution into the male genital tract has been largely limited to total, rather than protein-free drug concentrations in the whole ejaculate at one or two time points within a dosing interval, which may be misleading in understanding local drug action. Recent innovations enable a quantitative understanding of protein-free drug kinetics into semen and drug distribution into individual male genital tract glands. These methods may benefit therapeutics through optimization of targeted drug delivery and facilitate drug development for diseases related to these glands.
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Affiliation(s)
- Y-J Cao
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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14
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Cao YJ, Ndovi TT, Parsons TL, Guidos AM, Caffo B, Hendrix CW. Effect of semen sampling frequency on seminal antiretroviral drug concentration. Clin Pharmacol Ther 2007; 83:848-56. [PMID: 17914441 DOI: 10.1038/sj.clpt.6100356] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Study of male genital tract (MGT) pharmacology is relevant to the treatment of prostatitis, prostate cancer, infertility, and seminal human immunodeficiency virus transmission. However, the time course of drug concentrations in the MGT is largely unknown. To determine the feasibility of frequent semen sampling in assessing the pharmacokinetics of the MGT, we administered efavirenz, indinavir, and zidovudine to subjects to achieve steady-state levels and then collected semen samples at sequentially decreasing ejaculation intervals. The volume of seminal plasma decreased from 4.0 (1.2-5.1) ml (median with range) at 48 h after the baseline ejaculation to 0.72 (0.45-1.6) ml 1 h after a previous ejaculation, which was still adequate for drug concentration assessment. The seminal fructose concentration also decreased. However, the concentration of prostate-specific antigen and all three drugs did not decrease, even if the ejaculation intervals decreased to 1 h. Thus, semi-intensive semen sampling can be used to assess MGT pharmacokinetics.
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Affiliation(s)
- Y J Cao
- Division of Clinical Pharmacology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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15
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Lowe SH, van Leeuwen E, Droste JAH, van der Veen F, Reiss P, Lange JMA, Burger DM, Repping S, Prins JM. Semen Quality and Drug Concentrations in Seminal Plasma of Patients Using a Didanosine or Didanosine Plus Tenofovir Containing Antiretroviral Regimen. Ther Drug Monit 2007; 29:566-70. [PMID: 17898645 DOI: 10.1097/ftd.0b013e31811fef29] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Data on the concentrations of didanosine (ddI) and tenofovir (TFV) in seminal plasma are sparse. Subtherapeutic drug concentrations within the lumen of the male genital tract may have implications for selection and transmission of drug-resistant HIV strains. On the other hand, sufficient penetration of these drugs into the male genital tract has potential toxic effects on the spermatozoa and their precursors. In the current study, the authors obtained paired semen and blood samples at variable time points after drug intake from 30 HIV-1-infected patients using a ddI (n = 15) or ddI + TFV (n = 15) containing an antiretroviral regimen. Didanosine and TFV concentrations were measured in seminal and blood plasma and semen quality was assessed. Both ddI and TFV penetrated well into seminal plasma. Whereas blood plasma ddI concentrations dropped to near or below the lower limit of quantification of 0.017 microg/mL 9 hours after drug intake, the ddI concentration in seminal plasma remained detectable during the whole dosing interval with a median of 0.20 and 0.21 microg/mL in the ddI and ddI + TFV groups, respectively. Tenofovir was detectable during the whole dosing interval in both blood and seminal plasma with a median concentration of 0.12 and 0.25 microg/mL, respectively, and a median seminal-to-blood-plasma ratio of 3.3. Semen quality was within the normal range according to the criteria of the World Health Organization, except for the percentage of progressively motile sperm, which was low in both groups of patients. The authors conclude that ddI and TFV penetrate well into seminal plasma and that the reduced sperm motility deserves further study.
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Affiliation(s)
- Selwyn H Lowe
- Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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16
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Ndovi TT, Parsons T, Choi L, Caffo B, Rohde C, Hendrix CW. A new method to estimate quantitatively seminal vesicle and prostate gland contributions to ejaculate. Br J Clin Pharmacol 2007; 63:404-20. [PMID: 17076697 PMCID: PMC2203235 DOI: 10.1111/j.1365-2125.2006.02791.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Accepted: 05/03/2006] [Indexed: 11/27/2022] Open
Abstract
AIMS We sought to optimize a quantitative noninvasive method to determine the concentration in their glands of origin of biochemical markers of compartments of the male genital tract as the first step towards validation of a novel method for estimation of drug concentrations in these male genital tract compartments. METHODS Sixty-eight men participated. We compared four collection devices to split ejaculate into fractions. Fractions were assayed for fructose and prostate specific antigen (PSA) as unique markers of the seminal vesicle and prostate, respectively. Seminal vesicle fructose and prostatic PSA were estimated using a linear regression method, based on fructose-PSA axis intercepts, and compared with an older method which solves a simultaneous series of equations. RESULTS A five-compartment collection device performed best with mean (95% confidence interval) PSA vs. fructose r(2) of 0.84 (0.71, 0.98, P < 0.001). Using resampling simulations, glandular PSA and fructose estimates were highly variable and often implausible when using only two fractions. Using our method, the prostate contributed 37-44% to the whole ejaculate and the seminal vesicle contributed 55-61%. The novel regression method was highly correlated (r(2) > or = 0.98) with older methods. CONCLUSIONS We developed a noninvasive quantitative method of male genital tract biochemical marker estimation using a five-compartment tray to collect three to five ejaculate fractions. Our novel regression method is quantitative and more fully developed than older methods. This noninvasive method for determining glandular marker concentrations should be useful to provide quantitative estimates of drug concentrations in these glands.
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Affiliation(s)
- Themba T Ndovi
- School of Medicine, Department of Medicine, Division of Clinical Pharmacology, Baltimore, Maryland 21287, USA
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17
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Crommentuyn KML, Huitema ADR, Beijnen JH. Bioanalysis of HIV protease inhibitors in samples from sanctuary sites. J Pharm Biomed Anal 2005; 38:139-47. [PMID: 15907632 DOI: 10.1016/j.jpba.2004.12.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Revised: 12/09/2004] [Accepted: 12/10/2004] [Indexed: 10/25/2022]
Abstract
The human immunodeficiency virus (HIV) is present in several sites inside the human body, which are hardly accessible to antiretroviral drugs, the so-called sanctuary sites. The most important sanctuary sites are cerebrospinal fluid (CSF), peripheral blood mononuclear cells (PBMCs) and seminal plasma. The determination of drug concentrations in these sanctuary sites may form an important step in treatment optimisation of HIV-infected individuals. However, bioanalysis in these sites is hampered by several factors with regard to sample preparation, chromatography and detection. In this review, we will discuss these issues and give an overview of published methods using high-performance liquid chromatography (HPLC) for the bioanalysis of HIV protease inhibitors in CSF, PBMCs and seminal plasma.
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Affiliation(s)
- K M L Crommentuyn
- Slotervaart Hospital, Department of Pharmacy and Pharmacology, Louwesweg 6, 1066 EC Amsterdam, The Netherlands.
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18
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Lowe SH, Sankatsing SUC, Repping S, van der Veen F, Reiss P, Lange JMA, Prins JM. Is the male genital tract really a sanctuary site for HIV? Arguments that it is not. AIDS 2004; 18:1353-62. [PMID: 15199311 DOI: 10.1097/01.aids.0000125979.64033.96] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Selwyn H Lowe
- Department of Internal Medicine, Tropical Medicine and AIDS, International Antiviral Therapy Evaluation Center (IATEC), University of Amsterdam, Amsterdam, the Netherlands.
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Ghosn J, Viard JP, Katlama C, de Almeida M, Tubiana R, Letourneur F, Aaron L, Goujard C, Salmon D, Leruez-Ville M, Rouzioux C, Chaix ML. Evidence of genotypic resistance diversity of archived and circulating viral strains in blood and semen of pre-treated HIV-infected men. AIDS 2004; 18:447-57. [PMID: 15090797 DOI: 10.1097/00002030-200402200-00011] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the genetic diversity of drug-resistant HIV strains present in blood and in semen, especially those archived in peripheral blood mononuclear cells (PBMC) and non-sperm cells (NSC). METHODS Paired blood and semen samples were collected from twenty heavily pre-treated HIV-infected men. HIV RNA in blood plasma (BP) and seminal plasma (SP), as well as proviral DNA in PBMC and NSC were quantified and used for resistance genotyping. Phylogenetic analysis of protease gene clones was used to explore the diversity of the viral quasi-species. RESULTS Median BP HIV RNA, PBMC proviral DNA, SP HIV RNA and non-sperm cell proviral DNA loads were respectively: 4.77, 3.65, 3.16 and 1.77 log10 copies per ml or per 10 cells. Resistant HIV strains were found in the BP and PBMC of all the patients, in the SP of 14 patients, and in the NSC of five patients. Overall, the blood and genital compartments exhibited different genotypic resistance patterns in six patients (30%), with additional resistance mutations in the semen of four patients. Phylogenetic analysis of clones of HIV protease gene showed that viral strains in SP originated not only from passive diffusion from BP, but also from local production in semen. The storage of archived proviruses differed according to the anatomic reservoir. CONCLUSION HIV resistant strains are frequent (70%) in the semen of heavily pre-treated men, and the diversity of genotypic resistance pattern confirms HIV compartmentalization. Thus, the risk of sexual transmission of resistant strains can only be partly predicted by standard tests applied to BP.
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Affiliation(s)
- Jade Ghosn
- Laboratoire de Virologie, EA MRT 3620 Université R. Descartes, CHU Necker, Paris.
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Khoo SH, Hoggard PG, Williams I, Meaden ER, Newton P, Wilkins EG, Smith A, Tjia JF, Lloyd J, Jones K, Beeching N, Carey P, Peters B, Back DJ. Intracellular accumulation of human immunodeficiency virus protease inhibitors. Antimicrob Agents Chemother 2002; 46:3228-35. [PMID: 12234849 PMCID: PMC128776 DOI: 10.1128/aac.46.10.3228-3235.2002] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Intracellular accumulation of the protease inhibitors (PIs) saquinavir (SQV), ritonavir (RTV), and indinavir (IDV) was determined in 50 human immunodeficiency virus-positive patients. Following extraction, PIs were quantified by mass spectrometry. Paired plasma and intracellular samples were collected over a full dosing interval from patients (13 on SQV, 6 on RTV, 8 on IDV, 16 on SQV plus RTV, 7 on IDV plus RTV) with a plasma viral load of <400 copies/ml. Data were expressed as intracellular/plasma drug concentration ratios. A hierarchy of intracellular accumulation was demonstrated by the following medians: 9.45 for SQV > 1.00 for RTV > 0.51 for IDV. Coadministration of RTV did not boost ratios of SQV or IDV within the cell or in plasma, although absolute plasma and intracellular SQV concentrations were increased by RTV. Seven individuals receiving SQV in hard-gel capsule form (median, 32 months) had higher intracellular/plasma drug ratios than all other patients receiving SQV (median, 17.62 versus 4.83; P = 0.04), despite consistently low plasma SQV concentrations. How this occurs may provide insight into the mechanisms that limit adequate drug penetration into sanctuary sites.
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Affiliation(s)
- Saye H. Khoo
- Department of Pharmacology & Therapeutics, University of Liverpool, Department of Infectious Diseases, University Hospital Aintree, Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool, Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College, Department of Genitourinary Medicine, St. Thomas' Hospital, London, Department of Infectious Diseases, North Manchester General Hospital, Manchester, United Kingdom
| | - Patrick G. Hoggard
- Department of Pharmacology & Therapeutics, University of Liverpool, Department of Infectious Diseases, University Hospital Aintree, Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool, Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College, Department of Genitourinary Medicine, St. Thomas' Hospital, London, Department of Infectious Diseases, North Manchester General Hospital, Manchester, United Kingdom
- Corresponding author. Mailing address: Department of Pharmacology & Therapeutics, University of Liverpool, Block H, First Floor, 70 Pembroke Pl., Liverpool L69 3GF, United Kingdom. Phone: 44 151 794 5919. Fax: 44 151 794 5656. E-mail:
| | - Ian Williams
- Department of Pharmacology & Therapeutics, University of Liverpool, Department of Infectious Diseases, University Hospital Aintree, Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool, Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College, Department of Genitourinary Medicine, St. Thomas' Hospital, London, Department of Infectious Diseases, North Manchester General Hospital, Manchester, United Kingdom
| | - E. Rhiannon Meaden
- Department of Pharmacology & Therapeutics, University of Liverpool, Department of Infectious Diseases, University Hospital Aintree, Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool, Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College, Department of Genitourinary Medicine, St. Thomas' Hospital, London, Department of Infectious Diseases, North Manchester General Hospital, Manchester, United Kingdom
| | - Philippa Newton
- Department of Pharmacology & Therapeutics, University of Liverpool, Department of Infectious Diseases, University Hospital Aintree, Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool, Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College, Department of Genitourinary Medicine, St. Thomas' Hospital, London, Department of Infectious Diseases, North Manchester General Hospital, Manchester, United Kingdom
| | - Edmund G. Wilkins
- Department of Pharmacology & Therapeutics, University of Liverpool, Department of Infectious Diseases, University Hospital Aintree, Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool, Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College, Department of Genitourinary Medicine, St. Thomas' Hospital, London, Department of Infectious Diseases, North Manchester General Hospital, Manchester, United Kingdom
| | - Alan Smith
- Department of Pharmacology & Therapeutics, University of Liverpool, Department of Infectious Diseases, University Hospital Aintree, Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool, Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College, Department of Genitourinary Medicine, St. Thomas' Hospital, London, Department of Infectious Diseases, North Manchester General Hospital, Manchester, United Kingdom
| | - John F. Tjia
- Department of Pharmacology & Therapeutics, University of Liverpool, Department of Infectious Diseases, University Hospital Aintree, Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool, Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College, Department of Genitourinary Medicine, St. Thomas' Hospital, London, Department of Infectious Diseases, North Manchester General Hospital, Manchester, United Kingdom
| | - Judy Lloyd
- Department of Pharmacology & Therapeutics, University of Liverpool, Department of Infectious Diseases, University Hospital Aintree, Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool, Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College, Department of Genitourinary Medicine, St. Thomas' Hospital, London, Department of Infectious Diseases, North Manchester General Hospital, Manchester, United Kingdom
| | - Kevin Jones
- Department of Pharmacology & Therapeutics, University of Liverpool, Department of Infectious Diseases, University Hospital Aintree, Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool, Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College, Department of Genitourinary Medicine, St. Thomas' Hospital, London, Department of Infectious Diseases, North Manchester General Hospital, Manchester, United Kingdom
| | - Nick Beeching
- Department of Pharmacology & Therapeutics, University of Liverpool, Department of Infectious Diseases, University Hospital Aintree, Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool, Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College, Department of Genitourinary Medicine, St. Thomas' Hospital, London, Department of Infectious Diseases, North Manchester General Hospital, Manchester, United Kingdom
| | - Peter Carey
- Department of Pharmacology & Therapeutics, University of Liverpool, Department of Infectious Diseases, University Hospital Aintree, Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool, Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College, Department of Genitourinary Medicine, St. Thomas' Hospital, London, Department of Infectious Diseases, North Manchester General Hospital, Manchester, United Kingdom
| | - Barry Peters
- Department of Pharmacology & Therapeutics, University of Liverpool, Department of Infectious Diseases, University Hospital Aintree, Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool, Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College, Department of Genitourinary Medicine, St. Thomas' Hospital, London, Department of Infectious Diseases, North Manchester General Hospital, Manchester, United Kingdom
| | - David J. Back
- Department of Pharmacology & Therapeutics, University of Liverpool, Department of Infectious Diseases, University Hospital Aintree, Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool, Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College, Department of Genitourinary Medicine, St. Thomas' Hospital, London, Department of Infectious Diseases, North Manchester General Hospital, Manchester, United Kingdom
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Sankatsing SUC, Droste J, Burger D, Van Praag RME, Jurriaans S, Lange JMA, Prins JM. Limited penetration of lopinavir into seminal plasma of HIV-1-infected men. AIDS 2002; 16:1698-700. [PMID: 12172099 DOI: 10.1097/00002030-200208160-00023] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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