University of Venda / MSc (Microbiology)

MPH / Department of Public Health / HIV/AIDS is an overwhelming global pandemic that affects the country’s health-care system. In order to reduce HIV/AIDS morbidity and mortality, the World Health Organization has called on countries to provide earlier access to antiretroviral therapy. In order to comply with the World Health Organization’s call, South Africa has developed the National Consolidated Guidelines, which were aimed at increasing access to ART as well as reducing new infections through viral suppression. Although the new guidelines have been implemented, they have not been fully implemented, especially in rural-based Primary Health Care facilities. The researcher observed that women who were pregnant were not tested every three months, as prescribed by the HIV/AIDS guidelines. The aim of this study was to investigate Challenges faced by health professionals regarding the implementation of HIV/AIDS guidelines at PHC facilities of Vhembe District, South Africa. This study adopted a qualitative, explorative, descriptive and contextual approach targeting nurses working at rural-based primary health care facilities at Vhembe District. Face-to face in-depth, Semistructured interviews were conducted, audiotaped and transcribed verbatim. The study used non-probability quota sampling method to identify participants until data saturation was reached with 12 participants. The results revealed that nurses faced some challenges when implementing HIV/AIDS guidelines, including shortages of resources, poor technical support, poor infrastructure, work overload, patients starting ART while there are not ready, shortage of ART, late booking of antenatal care, and mothers’ denial of HIV positive status, HIV positive babies, and poor RPC after birth. Ethical considerations were observed throughout the study. The data collected was analyzed using interpretative phenomenological analysis and all measures to ensure trustworthiness of the study findings were ensured. Some recommendations were made based on the findings of the study / NRF

Human immunodeficiency virus (HIV) has become a global pandemic over the past few decades, with new infections and related deaths in the millions each year. There is no cure in sight for HIV-1 infection, and there has been little progress in developing an efficacious vaccine. Heterosexual transmission of HIV-1 remains the principal mode of transmission throughout the world and thus measures, such as topical vaginal microbicides, to prevent infection of the female reproductive tract are actively being explored. Recent trials of topical vaginal microbicides have shown that their interaction with the mucosal surfaces of the female reproductive tract as well as semen can hinder microbicide effectiveness against HIV-1 infection. Therefore, understanding the role these fluids play in HIV transmission would be critical towards developing effective antiviral prophylaxes. A recent study from our group demonstrated that human cervicovaginal secretions contained numerous cationic antimicrobial peptides and proteins, which collectively inhibited HIV-1 infection of target cells and tissues. To ascertain if human seminal plasma (SP), the main vector responsible for transmitting HIV-1, exhibited antiviral activity we utilized several antiHIV assays in the presence or absence of minimally manipulated SP. The majority of the intrinsic anti-HIV-1 activity of SP resided in the cationic polypeptide fraction. Antiviral assays utilizing luciferase reporter cells and lymphocytic cells revealed the ability of whole SP to prevent HIV-1 infection, even when SP was diluted 3200-fold. Subsequent fractionation by continuous flow acid-urea (AU)-PAGE and antiviral testing revealed that cationic polypeptides within SP were responsible for the majority of anti-HIV-1 activity. A proteomic approach was utilized to resolve and identify 52 individual cationic polypeptides that contribute to the aggregate anti-HIV-1 activity of SP. One peptide fragment of semenogelin I, termed SG-1, was purified from SP by a multi-step chromatographic approach, protein sequenced, and determined to exhibit anti-HIV-1 activity against HIV-1. Anti-HIV-1 activity was transient, as whole SP incubated for prolonged time intervals exhibited a proportional decrease in anti-HIV-1 activity that was directly attributed to the degradation of semenogelin I peptides. Collectively, these results indicate that the cationic polypeptide fraction of SP is active against HIV-1, and that semenogelin-derived peptides contribute to the intrinsic anti-HIV-1 activity of SP. Conversely, naturally occurring peptidic fragments from the SP-derived prostatic acid phosphatase (PAP) have been reported to form amyloid fibrils called "SEVI" capable of enhancing HIV-1 infection in vitro. In order to understand the biological consequence of this proviral effect, we extended these studies in the presence of human SP. PAP-derived peptides were agitated to form SEVI and incubated in the presence or absence of SP. While PAP-derived peptides and SEVI alone were proviral, the presence of 1% SP ablated their proviral activity in several different anti-HIV-1 assays. The anti-HIV-1 activity of SP was concentration dependent and was reduced following filtration. Supraphysiological concentrations of PAP peptides and SEVI incubated with diluted SP were degraded within hours, with SP exhibiting proteolytic activity at dilutions as high as 1:200. Sub-physiological concentrations of two prominent proteases of SP, prostate-specific antigen (PSA) and matriptase, could degrade physiological and supraphysiological concentrations of PAP peptides and SEVI. While human SP is a complex biological fluid, containing both antiviral and proviral factors, our results suggest that PAP peptides and SEVI may be subject to naturally occurring proteolytic components capable of reducing their proviral activity. Our studies demonstrate the overall antiviral activity of human SP, but there is still a critical need for effective topical vaginal microbicides that can prevent HIV-1 transmission. The synthetic human retrocyclins are cyclic antimicrobial peptides that are remarkably active against HIV-1, and are being developed as topical vaginal microbicides. Herein, we assessed whether the putative proviral SEVI was able to adversely affect the anti-HIV-1 activity of the retrocyclin analog RC-101. While SEVI alone enhanced viral infection, this effect was completely negated in the presence of RC-101. Retrocyclins such as RC-101 are inhibitors of HIV-1 entry, by preventing gp41-mediated viral fusion. Interestingly, using an HIV-1 reverse transcriptase (RT) specific assay, we also determined that RC-101 directly inhibited the activity of RT in a dose dependent manner, suggesting a secondary mechanism of viral inhibition. Our group has determined that RC-101 induces only a modest level of resistance in HIV, which may be due in part to RC-101's dual mechanisms of viral inhibition.

Lamivudina (3TC) e zidovudina (ZDV) são inibidores nucleosídeos da transcriptase reversa utilizados na terapêutica anti-HIV. Para avaliar a equivalência farmacêutica entre um medicamento teste contendo esta associação e o referência, foi desenvolvido um método para determinação cromatográfica simultânea de 3TC e ZDV em comprimidos. O método empregou coluna C8 Shim-pack®(150 x 4,6 mm, 5 µm), pré-coluna C18 Phenomenex® (50x4,6 mm 5um), água e metanol 60:40 (v:v) como fase móvel e detecção a 266nm. Este mostrou-se específico, com linearidade entre 45 a 5000 ng/mL, precisão demonstrada por CV% inferior a 5%, exatidão entre 90,0 e 110,0% com recuperação superior a 90% para ambos os fármacos. Os testes de dissolução apresentaram porcentagem de cedência média superior a 85% em 30 minutos. A biodisponibilidade relativa dos produtos Biovir® (referência) e Lamivudina + Zidovudina 150 + 300 mg (teste), foi avaliada por meio de um estudo quantitativo direto, cruzado e aberto. Para purificação das amostras biológicas contendo 3TC e ZDV foi realizada adição de acetato de amônio e dupla extração com acetato de etila. O método cromatográfico bioanalítico utilizou coluna C8 Shim-pack® (150 x 4,6 mm 5 µm) e pré-coluna C18 Phenomenex® (50 x 4,6 mm; 5 µm). Empregou-se sistema gradiente linear, combinando fase móvel A, tampão fosfato 0,01 M:acetonitrila (97:3 v/v) e fase móvel B, metanol, sob fluxo de 1,0 mL/min e detecção a 270 nm. Utilizou-se como padrão interno solução 10 µg/mL de estavudina. O método mostrou-se linear na faixa de concentração de 80 a 2500 ng/mL para 3TC e 80 a 5000 ng/mL para ZDV, com adequada precisão e exatidão intra-corridas e inter-corridas. As amostras plasmáticas mostraram-se estáveis a pelo menos três ciclos de congelamento e descongelamento e 48 horas à temperatura ambiente, após preparação. Os parâmetros farmacocinéticos calculados para 3TC foram: ASCo-t de 4936,10 ng.h/mL e 4760,07 ng.h/mL, ASCo-∞ de 5305,76 ng.h/mL e 5069,16 ng.h/mL; Cmax de 1526,33 ng/mL e 1585,61 ng/mL e tmax 1,04 h e 0,97 h, respectivamente, para os produtos referência e teste. Para ZDV os valores obtidos foram ASCo-t de 2341,32 ng.h/mL e 2538,17 ng.h/mL, ASCo-∞ de 2561,68 ng.h/mL e 2770,21 ng.h/mL e Cmax de 2406,56 ng/mL e 2652,80 ng/mL e tmax 0,60 h e 0,55 h, respectivamente, para os produtos referência e teste. Os intervalos de confiança 90% para as relações entre os parâmetros Cmax, ASCo-t e ASCo-∞ em escala logarítmica obtidos para ambos os fármacos após administração dos produtos referência e teste a 24 voluntários sadios, estiveram compreendidos entre os limites de 80 a 125% exceto pelo Cmax para ZDV. O coeficiente de variação intra-sujeito de 47% demonstrou a alta variabilidade da ZDV em relação ao Cmax. Estudos de permeabilidade indicaram que a ZDV tem alta permeabilidade e alta solubilidade (Classe I) e a 3TC apresenta moderada permeabilidade e alta solubilidade (Classe III) . A absorção destes não é afetada significativamente pelas glicoproteínas-P, o que não pode explicar a alta variabilidade in vivo da absorção de ZDV. / Lamivudine (3TC) and zidovudine (ZDV) are the nucleoside reverse transcriptase inhibitors, They are used in combinations of antiretroviral therapy. The switchability between one test product and reference could be proved if they are pharmaceutically equivalents and bioequivalents. This research beginning with development and validation of chromatographic method to 3TC and ZDV simultaneous determination in tablet. The HPLC system were used to assay and 266nm wavelength ultraviolet detector. Separation was performed using a C8 column (150 x 4,6 mm, 5 µm) Shim-pack®protected by a C18 column (50 x 4,6 mm, 5 µm) Phenomenex®. The mobile phase is composed of water and methanol 60:40 (v:v). This method was successfully applied to simultaneous determination to 3TC and ZDV without interference. It was validated over the range of 45 a 5000 ng/mL for both drugs with accurate from 90 to 110% and precision with variation lower than 5%. Extraction recoveries of the analytes were higher than 90%. The mean dissolution data about 3TC and ZDV were above than 85% in 30 minutes of dissolution test. The relative bioavailability between Biovir® (brand-name product) and Lamivudina + Zidovudina 150 + 300 mg (test product), was conducted for one direct quantitative, open and crossover study. The serial plasma sample of 3TC and ZDV collected after oral administration of brand-name product and test product, were analyzed using a validated high-performance liquid chromatography assay with UV detection in wavelength of 270 nm. The double liquid-liquid extraction was realized with additions of amonio acetat. A CLC-C8 (M) column (150 x 4,6 mm 5 µm) Shim-pack®and C18 column (50 x 4,6mm 5 µm) Phenomenex®, was eluted with two mobile phase in a linear gradient system at a flow-rate of 1 mL/min. The mobile phase A was composed by 0,01 M phosphate bufer:acetonitrile (97:3 v/v) and mobile phase B composed by methanol. A methanolic solution containing 10 µ g/mL of stavudine was used as internai standard. The method was linear over the range of 80 a 2500 ng/mL for 3TC and 80 a 5000 ng/mL for ZDV. It was shown adequate intra-day accuracy; inter-day accuracy and precision. The sample have been stable in three cycle of freezing and thawing and 48 hours in room temperature after thawing, purified and with mobile phase. The pharmacokinetic parameter estimates for 3TC, were: ASCo-t de 4936,10 ng.h/mL e 4760,07 ng.h/mL, ASCo-C/) de 5305,76 ng.h/mL e 5069,16 ng.h/mL; Cmax de 1526,33 ng/mL e 1585,61 ng/mL e tmax 1,04 h e 0,97 h, respectively for brand-name product and test product. The obtained values for ZDV were: ASCo-t de 2341 ,32 ng.h/mL e 2538,17 ng.h/mL, ASCo-if.l de 2561,68 ng.h/mL e 2770,21 ng.h/mL e Cmax de 2406,56 ng/mL e 2652,80 ng/mL e tmax 0,60 h e 0,55 h respectively for for brand-name product and test product. The 90% confidence intervals for Cmax, ASCo-t e ASCo-∞ for log¬transformed results for 3TC and ZDV after oral administration of brand-name product and test product to 24 health volunteers was between 80 to 125% except for Cmax of ZDV. The high variability of Cmax this was displayed by intra-individual coefficient of variation of 47%. Permeability results suggest that ZDV has a high permeability and high solubility (Class I) and Lamivudine presents moderate permeability and high solubility. (Class III). These results assume that P-gp do not affect significantly lamivudine and zidovudine absorption and can not explain the high variability of zidovudine absorption.

A presente tese traz, além de conceitos sobre a incorporação de tecnologias na saúde, uma abordagem da regulação institucional brasileira, junto com a descrição da história e do funcionamento dos medicamentos para tratamento da aids. Na segunda parte do trabalho, a partir de uma série de entrevistas, são descritos e analisados os percursos e processos da incorporação dos medicamentos anti-retrovirais no Brasil, a política pública na qual estão inseridos assim como a intermediação do programa governamental na introdução desta tecnologia. São identificadas também as instituições, grupos ou corporações - empresas farmacêuticas, Ministério da Saúde, médicos, pessoas que vivem com HIV e aids e Poder Judiciário, que atuam em três percursos da incorporação da tecnologia em questão. No percurso científico, há a validação da tecnologia através da realização de pesquisas com seres humanos e da elaboração de diretrizes clínicas. A fase regulatória da tecnologia, com seu registro oficial e sua etapa prescritiva, quando também ocorrem a promoção e marketing das empresas farmacêuticas e as ações judiciais que obrigam o poder público a fornecer os medicamentos, caracterizam o percurso transicional. Já no percurso mercantil conformam-se os aspectos relacionados à demanda, oferta, produção, preço, compra e venda dos anti-retrovirais. O estudo indica a ausência de uma atuação regulatória integrada e sistêmica do Estado sobre todos os percursos da incorporação dos anti-retrovirais. Também ressalta aspectos importantes para a melhor compreensão da introdução de novas tecnologias no Sistema Único de Saúde, ao mesmo tempo em que sugere a necessidade de novas estratégias que garantam a sustentabilidade da política brasileira de acesso universal ao tratamento da aids. / This thesis brings, in addition to concepts about the incorporation of technologies in health, an approach to the Brazilian institutional regulation, together with the description of the history and the functioning of medicines for the treatment of aids. In the second part of the work, based on a series of interviews, the courses and processes of the incorporation of antiretroviral drugs in Brazil are described and analyzed, just like the public policy in which they are inserted and the intermediation of the government program in the introduction of this technology. Also, we identify the institutions, groups or corporations - pharmaceutical companies, Surgeon General, doctors, people who live with HIV and aids and Judiciary Power -, who work in three courses of the incorporation of the technology in question. In the scientific course, there is the validation of the technology through research with human beings and the preparation of clinical guidelines. The regulatory phase of the technology, with its official register and its prescriptive stage, when the promotion and marketing of the pharmaceutical companies also occur, and also the legal actions that make the government provide the drugs, characterize the transition course. As for the mercantile course, it contains the aspects related to demand, supply, production, price, purchase and sale of antiretroviral drugs. The study shows the absence of an integrated, systemic regulatory action of the State on all the courses of the incorporation of the antiretroviral drugs. It also points out important aspects for better understanding the introduction of new technologies in the Unified Health System, whereas it suggests the need of new strategies in order to guarantee the sustainability of the Brazilian policy of universal access to the treatment of aids.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The objective was to analyze the factors related to the adherence to the antiretroviral treatment of adults with HIV/AIDS, who were treated at the University Hospital of Santa Maria. This is a cross-sectional study, with a quantitative approach, involving 179 adults subjected to antiretroviral treatment for the HIV/AIDS. The data collection was held from January to July 2012, after approval by the Research Ethics Committee from the Federal University of Santa Maria. We have used a research tool consisted of data about the economic, demographic, social and clinical profiles; the Brazilian version of the Cuestionário para la Evaluación de la Adhesión al Tratamiento Antiretroviral and the Scale of self-efficacy expectancy to the antiretroviral treatment. After checking for errors and inconsistencies, the statistical analysis was performed by using the program PASW ® Statistics (Predictive Analytics Software, from SPSS Inc., Chicago - USA), version 18.0 for Windows. Of the 179 adults undergoing antiretroviral treatment for the HIV/AIDS, 50,8% were male, 23,5% were aged from 45 to 49 years (average age 43,21, ± 10,48), 62,6% lived in the city of Santa Maria; in 68,6% the route of HIV transmission was the sexual one. The Cronbach s alpha indexes of the scale of adherence and of self-efficacy expectancy were, respectively, 0,78 and 0,93. Of the adults under antiretroviral treatment, 83,2% were defined as non-adherents (raw score ≥ 83; percentile ≥ 85). The self-efficacy expectancy for the adherence to the antiretroviral treatment showed an average of 95,04% (± 9,11). Through bivariate analysis, it was found a statistically significant relationship between adherence and breed, schooling, viral load, the act of keeping the follow-up of your health in the service, the propensity to alcoholism, change in the lifestyle and necessity to use psychiatric medications. We have found a high and positive correlation between self-efficacy expectancy to follow-up the treatment and the adherence to the antiretroviral treatment. It was also evidenced a significant relationship among adherence, schooling, the act of keeping the follow-up of your health in the service and change in the lifestyle. The adherence showed a significant and direct correlation with self-efficacy expectancy (r=0,637, p <0,01), time of diagnosis (r = - 0,175, p<0,05), low and reverse with the number of pills (r = - 0,301, p <0,01), very low between and treatment time (r = - 0,165, p <0,05), low and direct with the viral load (r = 0,344, p <0,01). We conclude that adherence to the antiretroviral therapy is related to numerous factors that might interfere with the effectiveness of the treatment. From the analysis of adherence and of factors that might influence in the antiretroviral treatment, one can establish strategies of individual and collective care towards this population. / O objetivo foi analisar os fatores relacionados à adesão ao tratamento antirretroviral de adultos com HIV/AIDS, atendidos no Hospital Universitário de Santa Maria. Estudo transversal, com abordagem quantitativa, envolvendo 179 adultos em tratamento antirretroviral para o HIV/AIDS. A coleta de dados foi realizada no período de janeiro a julho de 2012, após aprovação do Comitê de Ética em Pesquisa da Universidade Federal de Santa Maria. Utilizou-se um instrumento de pesquisa, composto por dados sobre o perfil econômico, demográfico, social e perfil clínico; a versão brasileira do Cuestionário para la Evaluación de la Adhesión al Tratamiento Antiretroviral e a Escala de expectativa de autoeficácia ao tratamento antirretroviral. Após a verificação de erros e inconsistências, a análise estatística foi realizada no programa PASW Statistics® (Predictive Analytics Software, da SPSS Inc., Chicago - USA) versão 18.0 for Windows. Dos 179 adultos em tratamento antirretroviral para o HIV/AIDS, 50,8% eram do sexo masculino, 23,5% encontravam-se na faixa etária de 45 a 49 anos, idade média (43,21, ± 10.48), 62,6% residiam no município de Santa Maria, em 68,6% a via de transmissão do HIV foi a sexual. O alfa de Cronbach da escala de adesão e de expectativa de autoeficácia foi, respectivamente, 0,78 e 0,93. Dos adultos em tratamento antirretroviral, 83,2% foram definidos como não aderentes (escore bruto ≥ 83; percentil ≥ 85). A expectativa de autoeficácia para a adesão ao tratamento antirretroviral apresentou média de 95,04% (± 9,11). Por meio da análise bivariada foi encontrada relação estatística significativa entre adesão e a raça, escolaridade, carga viral, ao como é manter o acompanhamento de sua saúde no serviço, a propensão para alcoolismo, mudança no estilo de vida, necessidade de utilizar medicações psiquiátricas. Identificou-se correlação alta e positiva entre expectativa de autoeficácia para seguir o tratamento e adesão ao tratamento antirretroviral. Evidenciou-se também relação significativa entre adesão, escolaridade, manter o acompanhamento de saúde no serviço e mudança no estilo de vida. A adesão apresentou correlação significativa alta e direta com expectativa de autoeficácia (r= 0,637, p<0,01), tempo de diagnóstico (r= - 0,175, p<0,05), baixa e inversa com número de comprimidos (r= - 0,301, p< 0,01), muito baixa entre e tempo de tratamento (r= - 0,165, p< 0,05), baixa e direta com a carga viral (r= 0,344, p<0,01). Conclui-se que adesão ao tratamento antirretroviral esta relacionada a inúmeros fatores que podem interferir na eficácia do tratamento. A partir da análise da adesão e dos fatores que podem influenciar no tratamento antirretroviral será possível estabelecer estratégias de cuidado individual e coletivo a esta população.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-01-13T11:03:19Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Alline Torquato Vasconcelos - 2014.pdf: 3499445 bytes, checksum: 93905607504e61e452d7ce82396c17a9 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-01-13T11:04:23Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Alline Torquato Vasconcelos - 2014.pdf: 3499445 bytes, checksum: 93905607504e61e452d7ce82396c17a9 (MD5) / Made available in DSpace on 2015-01-13T11:04:23Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Alline Torquato Vasconcelos - 2014.pdf: 3499445 bytes, checksum: 93905607504e61e452d7ce82396c17a9 (MD5) Previous issue date: 2014-06-06 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Lamivudine (β-L-2',3'-dideoxy-3'-thiacytidine, 3TC) is a nucleoside-based anti-HIV/HBV drug that has provided insights into the nucleic acid double-stranded helix assembly. Two crystal structures thereof assembled with nucleobase pairing and helical stacking as mimicries of DNA, but without the phosphodiester linkages in the fiber periphery, have recently demonstrated that nucleosides bring themselves the chemical information to assemble DNA duplexes even if the covalent backbone is absent. Here, we report the third structural example in which nucleosides are base-paired and helically base-stacked. A DNA-like double stranded helix was prepared cocrystallizing lamivudine with fumaric acid. We have named it as lamivudine duplex III. When substituting maleic acid present in the first example of lamivudine duplex for its trans-stereoisomer, the formation of a DNA-mimicry is still observed but with changes in the crystal stoichiometry, nucleobase pairing pattern and duplex backbone. Lamivudine duplex III exhibits both base pairing motifs present in the antecedent duplexes. In this structure, there are four protonated lamivudine molecules paired in-plane with four neutral ones. These crystallographically independent base pairs are held together through three hydrogen bonds as occurs in lamivudine duplex I made up of cytosine-cytosine+ base pairing only. But, contrarily to the duplex I with pairing between neutral and cationic drug units only, the duplex III has one neutral 3TC=3TC pair in its asymmetric unit. These molecules are kept in contact through only two peripheral N―H•••O hydrogen bonds as in two of the three neutral lamivudine pairs of the second example of lamivudine duplex. In both structures, each neutral pair is face-to-face stacked on top of one another and face-to-tail stacked on bottom of another one. Even in agreement with its higher structural complexity, the duplex III is present with very puckering conformations besides the three different orientations of the OH moiety at C5’. Five-membered oxathiolane ring adopts three envelop puckering modes and two twist conformations. This is the first report of a twist pucker for lamivudine despite of the large number of reported crystal structures thereof. Another remarkable characteristic of the duplex III is in its fiber periphery. There are hydrogen bonds between the 5’-OH moieties of neighbor pairs pointing in the direction of the missing phosphodiester linkages that would covalently bond two adjacent monomers in the strand. Furthermore, the geometry of these interactions reveals the antiparallel orientation of each strand relative to one another into the nucleoside duplex backbone. Noteworthy similarities between the duplexes crystallizing together with either hydrogen maleate or hydrogen fumarate are their left handedness and the outline of surface grooves of similar depth. But, while all hydrogen maleate counterions are lodged on the grooves of the duplex I, some hydrogen fumarate units are also interacting with themselves into one-dimensional chain of counterions. The third example of unusual double-stranded helices of lamivudine strengthens the fact that nucleosides can self-aggregate into DNA-like duplexes even without the covalent phosphodiester linkages in fiber periphery. Besides that, the structure described here adds knowledge on lamivudine versatility to assemble DNA-mimicry in crystals. / A lamivudina (β-L-2',3'-dideoxy-3'-thiacytidine, 3TC) é um fármaco a base de nucleosídeos utilizado para o tratamento de SIDA e Hepatite B. A obtenção de estruturas do tipo dupla hélice de ácidos nucleicos com esse fármaco tem sido alvo de estudo. Recentemente foram reportadas duas estruturas cristalinas mimetizando DNA, formadas por pares de nucleosídeos empacotados em uma dupla hélice, mas sem ligações fosfodiéster na periferia da cadeia. Estas estruturas demonstraram que os nucleosídeos possuem informação química suficiente para a formação de estruturas dessa natureza mesmo com a ausência das ligações covalentes fosfodiéster. Neste trabalho um terceiro exemplo de uma estrutura contendo bases de nuclosídeos pareadas e sobrepostas helicoidalmente, mimetizando DNA, é reportado. Essa modificação cristalina foi preparada através da cocristalização da lamivudina com o ácido fumárico e a estrutura obtida foi denominada duplex III. Com a substituição do ácido maleico, presente no primeiro exemplo de dupla hélice de lamivudina, pelo seu estéreoisômero trans, o ácido fumárico, a formação de uma estrutura mimetizando o DNA também foi observada, porém, com diferenças na estequiometria do cristal, nos padrões de interação do pareamento das bases, assim como no esqueleto da dupla hélice. O pareamento das bases na duplex III de lamivudina possui padrões de interação semelhante a ambas estruturas precedentes. Na duplex III existem quatro pares parcialmente protonados, onde uma lamivudina protonada está pareada com outra neutra. Esse tipo de pareamento se dá através de três ligações de hidrogênio e é semelhante ao pareamento presente na estrutura da duplex I de lamivudina composto apenas por pares do tipo 3TC+≡3TC. Diferentemente da duplex I que possui exclusivamente pares parcialmente protonados, a duplex III possui também um par neutro do tipo 3TC=3TC na sua unidade assimétrica. O pareamento dessas bases é formado apenas por duas ligações de hidrogênio do tipo N―H•••O, semelhante a dois dos três pares neutros que constituem a duplex II de lamivudina. O empacotamento dos pares neutros na duplex III é semelhante ao da duplex II, cada par neutro empacota com uma padrão face a face com o par que o antecede e face a cauda com o par subsequente. Devido à grande complexidade estrutural da duplex III, temos uma maior variação nas conformações assumidas tanto pelo anel oxatiolano quanto pelo fragmento citosinico, assim como nas três orientações adotadas pelo grupo hidroxílico ligado ao carbono C5’. O anel oxatiolano de cinco membros, adota três diferentes conformações do tipo envelope e duas conformações do tipo cambaleante. Apesar de essas serem as primeiras estruturas reportadas com conformações do tipo cambaleante para a lamivudina, esse tipo de conformação é comum para várias outras estruturas cristalinas. Outra característica que merece destaque na estrutura obtida da duplex III está nos padrões de interação presentes na periferia da dupla hélice. Nota-se a presença de ligações de hidrogênio entre os grupos 5’-OH de pares vizinhos, que ocorrem na direção onde as ligações fosfodiéster deveriam existir entre dois monômeros adjacentes. Além disso, a geometria dessas ligações de hidrogênio revelam uma orientação antiparalela de uma fita em relação a outra no esqueleto da duplex. Existem algumas semelhanças notáveis entre as duplexes I e III, cristalizadas com hidrogenomaleato e hidrogenofumarato, como a espiralização a esquerda e o fato de ambas não possuírem diferença entre sulcos principais e secundários, uma vez que todos os sulcos ao longo da cadeia possuem dimensões semelhantes. Porém, todos os contraíons estão acomodados nos sulcos da duplex I, enquanto que na duplex III alguns contraíons interagem entre si formando uma cadeia unidimensional de contraíons. Esse terceiro exemplo de uma estrutura atípica de dupla hélice de lamivudina reforça o fato de que nucleosídeos podem se agregar em estruturas semelhantes a dupla hélice do DNA, mesmo com a ausência das ligações covalentes fosfodiéster. Além disso a estrutura da duplex III adiciona conhecimento quanto a versatilidade da lamivudina em formar estruturas mimetizando DNA em cristais.

Lamivudina (3TC) e zidovudina (ZDV) são inibidores nucleosídeos da transcriptase reversa utilizados na terapêutica anti-HIV. Para avaliar a equivalência farmacêutica entre um medicamento teste contendo esta associação e o referência, foi desenvolvido um método para determinação cromatográfica simultânea de 3TC e ZDV em comprimidos. O método empregou coluna C8 Shim-pack&#174;(150 x 4,6 mm, 5 &#181;m), pré-coluna C18 Phenomenex&#174; (50x4,6 mm 5um), água e metanol 60:40 (v:v) como fase móvel e detecção a 266nm. Este mostrou-se específico, com linearidade entre 45 a 5000 ng/mL, precisão demonstrada por CV% inferior a 5%, exatidão entre 90,0 e 110,0% com recuperação superior a 90% para ambos os fármacos. Os testes de dissolução apresentaram porcentagem de cedência média superior a 85% em 30 minutos. A biodisponibilidade relativa dos produtos Biovir&#174; (referência) e Lamivudina + Zidovudina 150 + 300 mg (teste), foi avaliada por meio de um estudo quantitativo direto, cruzado e aberto. Para purificação das amostras biológicas contendo 3TC e ZDV foi realizada adição de acetato de amônio e dupla extração com acetato de etila. O método cromatográfico bioanalítico utilizou coluna C8 Shim-pack&#174; (150 x 4,6 mm 5 &#181;m) e pré-coluna C18 Phenomenex&#174; (50 x 4,6 mm; 5 &#181;m). Empregou-se sistema gradiente linear, combinando fase móvel A, tampão fosfato 0,01 M:acetonitrila (97:3 v/v) e fase móvel B, metanol, sob fluxo de 1,0 mL/min e detecção a 270 nm. Utilizou-se como padrão interno solução 10 &#181;g/mL de estavudina. O método mostrou-se linear na faixa de concentração de 80 a 2500 ng/mL para 3TC e 80 a 5000 ng/mL para ZDV, com adequada precisão e exatidão intra-corridas e inter-corridas. As amostras plasmáticas mostraram-se estáveis a pelo menos três ciclos de congelamento e descongelamento e 48 horas à temperatura ambiente, após preparação. Os parâmetros farmacocinéticos calculados para 3TC foram: ASCo-t de 4936,10 ng.h/mL e 4760,07 ng.h/mL, ASCo-&#8734; de 5305,76 ng.h/mL e 5069,16 ng.h/mL; Cmax de 1526,33 ng/mL e 1585,61 ng/mL e tmax 1,04 h e 0,97 h, respectivamente, para os produtos referência e teste. Para ZDV os valores obtidos foram ASCo-t de 2341,32 ng.h/mL e 2538,17 ng.h/mL, ASCo-&#8734; de 2561,68 ng.h/mL e 2770,21 ng.h/mL e Cmax de 2406,56 ng/mL e 2652,80 ng/mL e tmax 0,60 h e 0,55 h, respectivamente, para os produtos referência e teste. Os intervalos de confiança 90% para as relações entre os parâmetros Cmax, ASCo-t e ASCo-&#8734; em escala logarítmica obtidos para ambos os fármacos após administração dos produtos referência e teste a 24 voluntários sadios, estiveram compreendidos entre os limites de 80 a 125% exceto pelo Cmax para ZDV. O coeficiente de variação intra-sujeito de 47% demonstrou a alta variabilidade da ZDV em relação ao Cmax. Estudos de permeabilidade indicaram que a ZDV tem alta permeabilidade e alta solubilidade (Classe I) e a 3TC apresenta moderada permeabilidade e alta solubilidade (Classe III) . A absorção destes não é afetada significativamente pelas glicoproteínas-P, o que não pode explicar a alta variabilidade in vivo da absorção de ZDV. / Lamivudine (3TC) and zidovudine (ZDV) are the nucleoside reverse transcriptase inhibitors, They are used in combinations of antiretroviral therapy. The switchability between one test product and reference could be proved if they are pharmaceutically equivalents and bioequivalents. This research beginning with development and validation of chromatographic method to 3TC and ZDV simultaneous determination in tablet. The HPLC system were used to assay and 266nm wavelength ultraviolet detector. Separation was performed using a C8 column (150 x 4,6 mm, 5 &#181;m) Shim-pack&#174;protected by a C18 column (50 x 4,6 mm, 5 &#181;m) Phenomenex&#174;. The mobile phase is composed of water and methanol 60:40 (v:v). This method was successfully applied to simultaneous determination to 3TC and ZDV without interference. It was validated over the range of 45 a 5000 ng/mL for both drugs with accurate from 90 to 110% and precision with variation lower than 5%. Extraction recoveries of the analytes were higher than 90%. The mean dissolution data about 3TC and ZDV were above than 85% in 30 minutes of dissolution test. The relative bioavailability between Biovir&#174; (brand-name product) and Lamivudina + Zidovudina 150 + 300 mg (test product), was conducted for one direct quantitative, open and crossover study. The serial plasma sample of 3TC and ZDV collected after oral administration of brand-name product and test product, were analyzed using a validated high-performance liquid chromatography assay with UV detection in wavelength of 270 nm. The double liquid-liquid extraction was realized with additions of amonio acetat. A CLC-C8 (M) column (150 x 4,6 mm 5 &#181;m) Shim-pack&#174;and C18 column (50 x 4,6mm 5 &#181;m) Phenomenex&#174;, was eluted with two mobile phase in a linear gradient system at a flow-rate of 1 mL/min. The mobile phase A was composed by 0,01 M phosphate bufer:acetonitrile (97:3 v/v) and mobile phase B composed by methanol. A methanolic solution containing 10 &#181; g/mL of stavudine was used as internai standard. The method was linear over the range of 80 a 2500 ng/mL for 3TC and 80 a 5000 ng/mL for ZDV. It was shown adequate intra-day accuracy; inter-day accuracy and precision. The sample have been stable in three cycle of freezing and thawing and 48 hours in room temperature after thawing, purified and with mobile phase. The pharmacokinetic parameter estimates for 3TC, were: ASCo-t de 4936,10 ng.h/mL e 4760,07 ng.h/mL, ASCo-C/) de 5305,76 ng.h/mL e 5069,16 ng.h/mL; Cmax de 1526,33 ng/mL e 1585,61 ng/mL e tmax 1,04 h e 0,97 h, respectively for brand-name product and test product. The obtained values for ZDV were: ASCo-t de 2341 ,32 ng.h/mL e 2538,17 ng.h/mL, ASCo-if.l de 2561,68 ng.h/mL e 2770,21 ng.h/mL e Cmax de 2406,56 ng/mL e 2652,80 ng/mL e tmax 0,60 h e 0,55 h respectively for for brand-name product and test product. The 90% confidence intervals for Cmax, ASCo-t e ASCo-&#8734; for log¬transformed results for 3TC and ZDV after oral administration of brand-name product and test product to 24 health volunteers was between 80 to 125% except for Cmax of ZDV. The high variability of Cmax this was displayed by intra-individual coefficient of variation of 47%. Permeability results suggest that ZDV has a high permeability and high solubility (Class I) and Lamivudine presents moderate permeability and high solubility. (Class III). These results assume that P-gp do not affect significantly lamivudine and zidovudine absorption and can not explain the high variability of zidovudine absorption.

A presente tese traz, além de conceitos sobre a incorporação de tecnologias na saúde, uma abordagem da regulação institucional brasileira, junto com a descrição da história e do funcionamento dos medicamentos para tratamento da aids. Na segunda parte do trabalho, a partir de uma série de entrevistas, são descritos e analisados os percursos e processos da incorporação dos medicamentos anti-retrovirais no Brasil, a política pública na qual estão inseridos assim como a intermediação do programa governamental na introdução desta tecnologia. São identificadas também as instituições, grupos ou corporações - empresas farmacêuticas, Ministério da Saúde, médicos, pessoas que vivem com HIV e aids e Poder Judiciário, que atuam em três percursos da incorporação da tecnologia em questão. No percurso científico, há a validação da tecnologia através da realização de pesquisas com seres humanos e da elaboração de diretrizes clínicas. A fase regulatória da tecnologia, com seu registro oficial e sua etapa prescritiva, quando também ocorrem a promoção e marketing das empresas farmacêuticas e as ações judiciais que obrigam o poder público a fornecer os medicamentos, caracterizam o percurso transicional. Já no percurso mercantil conformam-se os aspectos relacionados à demanda, oferta, produção, preço, compra e venda dos anti-retrovirais. O estudo indica a ausência de uma atuação regulatória integrada e sistêmica do Estado sobre todos os percursos da incorporação dos anti-retrovirais. Também ressalta aspectos importantes para a melhor compreensão da introdução de novas tecnologias no Sistema Único de Saúde, ao mesmo tempo em que sugere a necessidade de novas estratégias que garantam a sustentabilidade da política brasileira de acesso universal ao tratamento da aids. / This thesis brings, in addition to concepts about the incorporation of technologies in health, an approach to the Brazilian institutional regulation, together with the description of the history and the functioning of medicines for the treatment of aids. In the second part of the work, based on a series of interviews, the courses and processes of the incorporation of antiretroviral drugs in Brazil are described and analyzed, just like the public policy in which they are inserted and the intermediation of the government program in the introduction of this technology. Also, we identify the institutions, groups or corporations - pharmaceutical companies, Surgeon General, doctors, people who live with HIV and aids and Judiciary Power -, who work in three courses of the incorporation of the technology in question. In the scientific course, there is the validation of the technology through research with human beings and the preparation of clinical guidelines. The regulatory phase of the technology, with its official register and its prescriptive stage, when the promotion and marketing of the pharmaceutical companies also occur, and also the legal actions that make the government provide the drugs, characterize the transition course. As for the mercantile course, it contains the aspects related to demand, supply, production, price, purchase and sale of antiretroviral drugs. The study shows the absence of an integrated, systemic regulatory action of the State on all the courses of the incorporation of the antiretroviral drugs. It also points out important aspects for better understanding the introduction of new technologies in the Unified Health System, whereas it suggests the need of new strategies in order to guarantee the sustainability of the Brazilian policy of universal access to the treatment of aids.

As the first structural example of this class of proteins, crystals of Pro-RIP and MOD were grown and diffracted to 2.4 and 2.5 A respectively. The structures of the two proteins are solved and found to be highly similar, with main chain RMSD of 0.519. Each protein has two domains. The N-terminal domain consists of five alpha-helices and five-stranded mixed beta-sheet. The conserved active site residues Y94, Y130, E207, R210 and W241, similar to those of other RIPs, are located at the cleft between the N-terminal and C-terminal domains. In Pro-RIP, the 25-amino acid internal inactivation region is found on the surface of the N-terminal domain and consists of a flexible loop followed by a long alpha-helix. Like bacterial ribosome-inactivating proteins, maize ribosome-inactivating protein does not have a back-up glutamate in the active site, which helps the protein to retain some activity if the catalytic glutamate is mutated. The structure of maize RIP reveals that the active site is too small to accommodate two glutamate residues and suggests that maize ribosome-inactivating protein may represent an intermediate product in the evolution of ribosome-inactivating proteins. / Pull-down assay indicated that the internal inactivation region diminished the interaction of Pro-RIP with purified ribosomes and ribosomal proteins P0, P1 and P2. Surface plasmon resonance assays showed that Pro-RIP has a slower association rate and faster dissociation rate on intact ribosomes when compared to MOD, resulting 80-fold decrease in binding affinity. These evidences strongly suggested that the reduced ribosome-inactivating activity and cytotoxicity of Pro-RIP is the result of its diminished interaction with the ribosomes. The ribosome binding site of MOD is found to be different from TCS and saporin, which are located between the anti-parallel beta-sheet in the C-terminal domain. In MOD, the positive-charged residues K158, K159, K160 and K161 that were found to be important for ribosome binding are located in the N-terminal domain, underneath the internal inactivation region. / Ribosome-inactivating proteins (RIPs) are rRNA N-glycosidases, which hydrolyze the N-glycosidic bond of A-4324 in 28S rRNA of eukaryotic ribosomes. Based on the number of subunits, RIPs are grouped into three classes. Type I RIPs (e.g. trichosanthin and saporin) are monomeric polypeptide with molecular weights of 25-32 kDa. Type II RIPs (e.g. ricin and cinnamomin) are heterodimeric proteins whose subunits are linked by a disulphide bridge, with molecular weights of 60-65 kDa. Chain A of type II RIPs is the catalytic subunit, while chain B is the lectin subunit, which facilitates the cellular entry of the protein by interacting with carbohydrates on the cell surface. Maize ribosome-inactivating protein is classified as a type III RIP, or an atypical RNA N-glycosidase. It is synthesized and stored in the kernel as a 34 kDa inactive precursor (Pro-RIP). During germination, the precursor undergoes proteolysis to generate a two-chain active RIP (MOD). Previous study has found that the 25-amino acid residues at the acidic internal inactivation region, which are removed during activation of Pro-RIP, is the major control element to suppress its in vitro protein synthesis inhibition activity. / Since the internal inactivation region of Pro-RIP controls the ribosome-inactivating activity and cytotoxicity, it provides an opportunity to engineer an on/off switch forits activity by HIV-1 protease through engineering HIV-1 protease recognition sites into the internal inactivation region of Pro-RIP. A variant that contains two HIV-1 protease recognition sites incorporated to the 25-amino acid internal inactivation region was found to be activated by HIV-1 protease in vitro. This variant entered cells more efficiently than Pro-RIP and was as cytotoxic as MOD. This switch may be applied to other RIPs such as ricin A chain and other protease recognition sequences may be used for increasing the specificity of an RIP toward viral infected cells. / The internal inactivation region of Pro-RIP greatly decreases its cytotoxicity, but not cellular uptake through alpha-2 macroglobulin receptor. On the contrary, the acidic residues within the region hinder fluid-phase endocytosis. Moreover, it is found that the internal inactivation region does not affect sub-cellular localization of the protein - MOD and Pro-RIP locate in the same cellular compartment (nucleus in JAR or cytoplasm in J774A.1 and C8166). / Mak, Nga Sze Amanda. / "July 2007." / Adviser: Shaw Pang Chui. / Source: Dissertation Abstracts International, Volume: 73-03, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 216-236). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.