The drug-drug interaction involving zidovudine and sulfamethoxazole-trimethoprim was investigated using an in vitro culture system, an in vivo mouse model, and a clinical trial in HIV-infected patients. We hypothesized that combination exposure causes immune cell populations in the bone marrow to undergo apoptotic cell death, and that the toxicity would affect the host response to an infectious stimulus. Mice were dosed with zidovudine, sulfamethoxazole-trimethoprim, the combination of both drugs, or vehicle only control via oral gavage. Focusing on B-lineage cells in the bone marrow, we determined that cells of the rapidly cycling, early pre-B cell subset are targeted, as well as pro-B cells earlier in development. This toxicity was found to be cell cycle dependent, with an increase in percentage of cells in the S/G2/M phases of the cycle. In vitro experiments using the drugs in a bone marrow culture system demonstrated that the effect of cytotoxicity with combination exposure is synergistic and concentration-dependent. The mechanism of apoptosis that is induced appears to be caspase-independent. To measure host response in mice, animals treated with zidovudine plus sulfamethoxazole-trimethoprim were infected with Pneumocystis murina pneumonia, and the group that received the combination of agents had a blunted antigen-specific IgG response, possibly due to a decreased number of B cells and activated B cells in the draining lymph nodes of the lungs. A clinical trial was conducted in HIV-infected patients, dividing subjects into groups receiving zidovudine, sulfamethoxazole-trimethoprim, the combination of both, or neither agent. Upon vaccination with the influenza vaccine, the combination treatment group had a blunted humoral response, with reduced antigen-specific serum IgG titers as compared to the control group. We conclude that the drug-drug interaction involving zidovudine and sulfamethoxazole-trimethoprim is clinically-significant, and clinicians must consider this toxicity when treating patients with these agents concurrently.

Thesis (M.S.)--University of Florida, 2004. / Typescript. Title from title page of source document. Document formatted into pages; contains 186 pages. Includes Vita. Includes bibliographical references.

A paracoccidioidomicose (PCM), doença sistêmica de caráter granulomatoso, causada pelo fungo termodimórfico Paracoccidioides brasiliensis. A PCM é endêmica na América Latina e atinge principalmente indivíduos do sexo masculino com atividades econômica ligada a agricultura. Os pacientes com PCM exigem tratamento a base de sulfametoxazol/trimetoprim, anfotericina B, e derivados azólicos por longos períodos. A gp43, possui 416 aminoácidos, onde um trecho específico de 15 aminoácidos (QTLIAIHTLAIRYAN) designado como (P10), é reconhecido pelos linfócitos T de camundongos e humanos. No presente estudo avaliamos o efeito aditivo da imunização do P10 com às drogas antifúngicas utilizadas no tratamento da PCM. Nossos resultados indicam um efeito aditivo entre a imunização com P10 e o tratamento medicamentoso em camundongos Balb/c infectados. Associado a redução significativa da carga fúngica no pulmão, baço e fígado desses animais, detectamos aumento dos níveis de IL-12 e IFN-? e diminuição de IL-4 e IL-10. / Paracoccidioidomycosis (PCM) is a systemic granulomatous disease caused by Paracoccidioides brasiliensis, a thermal dimorphic fungus. PCM is endemic in Latin America affecting mainly rural workers. The patients with PCM demand treatment the base of sulfametoxazole/trimethoprim, amphotericin B and derivatives azolic. The gp43 has 416-mer and mice and human T lymphocytes are stimulated by a 15-mer peptide designated as P10 (QTLIAIHTLAIRYAN). In the present work we evaluated the additive effect of P10 immunization and antifungal drugs utilizing in PCM treatment. Ours results showed an additive protective effect between immunization with P10 and drugs treatment with infected Balb/c mice. Associated to the reduction of fungal burden in the lung, spleen and liver we observed increase of levels of IL-12 and IFN-? and reduction of IL-4 and IL-10.

A paracoccidioidomicose (PCM), doença sistêmica de caráter granulomatoso, causada pelo fungo termodimórfico Paracoccidioides brasiliensis. A PCM é endêmica na América Latina e atinge principalmente indivíduos do sexo masculino com atividades econômica ligada a agricultura. Os pacientes com PCM exigem tratamento a base de sulfametoxazol/trimetoprim, anfotericina B, e derivados azólicos por longos períodos. A gp43, possui 416 aminoácidos, onde um trecho específico de 15 aminoácidos (QTLIAIHTLAIRYAN) designado como (P10), é reconhecido pelos linfócitos T de camundongos e humanos. No presente estudo avaliamos o efeito aditivo da imunização do P10 com às drogas antifúngicas utilizadas no tratamento da PCM. Nossos resultados indicam um efeito aditivo entre a imunização com P10 e o tratamento medicamentoso em camundongos Balb/c infectados. Associado a redução significativa da carga fúngica no pulmão, baço e fígado desses animais, detectamos aumento dos níveis de IL-12 e IFN-? e diminuição de IL-4 e IL-10. / Paracoccidioidomycosis (PCM) is a systemic granulomatous disease caused by Paracoccidioides brasiliensis, a thermal dimorphic fungus. PCM is endemic in Latin America affecting mainly rural workers. The patients with PCM demand treatment the base of sulfametoxazole/trimethoprim, amphotericin B and derivatives azolic. The gp43 has 416-mer and mice and human T lymphocytes are stimulated by a 15-mer peptide designated as P10 (QTLIAIHTLAIRYAN). In the present work we evaluated the additive effect of P10 immunization and antifungal drugs utilizing in PCM treatment. Ours results showed an additive protective effect between immunization with P10 and drugs treatment with infected Balb/c mice. Associated to the reduction of fungal burden in the lung, spleen and liver we observed increase of levels of IL-12 and IFN-? and reduction of IL-4 and IL-10.