The great adaptability of the Human Immunodeficiency Virus type 1 (HIV-1) and the exclusive use of zidovudine (3$ sp prime$azido-3$ sp prime$deoxythymidine or AZT) in the treatment of AIDS has motivated our search for HIV-1 strains resistant to this drug. / Our first attempt at obtaining such strains was made by using an in vitro approach in which a lymphoid cell line, chronically infected with HIV-1, was exposed to various drug concentrations. Although this system has never generated such mutants, we found that the progeny virus population, present in the culture fluids of these chronically infected drug-treated cells lost infectivity. These results suggest a potential post-integrational role for zidovudine, possibly acting at the level of viral assembly or budding. / However, we were successful in isolating zidovudine-resistant HIV-1 strains from the blood of patients undergoing AZT treatment. Our work shows that a minimum of 27 weeks of treatment is necessary for the appearance of the resistant phenotype and that the majority (75%) of patients treated with AZT for more than one year will generate such resistant strains. No correlation between the clinical status of the patients and the occurrence of resistant variants can be drawn from our work. However, in vitro experiments have shown that the resistant isolates are more cytopathic, although less infectious, than the sensitive strains. Reverse transcriptase enzymes from both AZT-resistant and -sensitive strains were virtually identical when their respective enzymatic activities or their affinity for the substrate or the inhibitor were compared. Finally, some zidovudine-resistant isolates demonstrate cross-resistance to other nucleoside analogs with potential clinical applications.

No description available.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-04-03T15:40:58Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) 13.09.16 dissertação .pdf: 1795574 bytes, checksum: 69b2e4f379a6d4cddabad843b16888e1 (MD5) / Made available in DSpace on 2017-04-03T15:40:58Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) 13.09.16 dissertação .pdf: 1795574 bytes, checksum: 69b2e4f379a6d4cddabad843b16888e1 (MD5) Previous issue date: 2015-07-06 / Os Insumos Farmacêuticos Ativos (IFAs) são considerados uma nova classe de micropoluentes orgânicos ambientais podendo causar impactos negativos aos ecossistemas. As indústrias farmacêuticas são umas das responsáveis por essa poluição, por isso buscam novos métodos para tratar seus efluentes. Dentre esses fármacos tem-se a Zidovudina (AZT) que pode ser considerado um poluente de difícil degradação nos efluentes industriais via processos convencionais, o que motivou o desenvolvimento de um método de degradação eletroquímico com baixos custos através de uma eletrólise. O AZT foi doado pelo Laboratório Farmacêutico do Estado de Pernambuco (LAFEPE), e caracterizado através de análise termogravimétrica, espectroscopia de absorção na região do infravermelho e difração de raios-X de pó. Como técnicas analíticas, a voltametria de pulso diferencial foi a primeira a ser explorada, utilizando eletrodos de amálgama de mercúrio e carbono vítreo com e sem deposição de zinco na superfície, para pH de 7,2 e 9,6, solução de tampão sódio-potássio de AZT 16 mm, a fim de identificar o melhor pico de redução. Os resultados mostram que o AZT sofre degradação com o eletrodo de amálgama e de carbono vítreo, esse último em menor intensidade. Em busca de uma técnica menos poluente, o eletrodo de carbono vítreo foi o que melhor se enquadrou à proposta de descontaminação de efluentes. As condições ótimas para essa degradação foram solução de tampão sódio-potássio de AZT 16 mm em pH 9,6, com uma corrente (I) de 0,04 A e tempo de reação de 24 horas, em que os resultados obtidos com a Cromatografia Líquida de Alta Eficiência (CLAE) revelaram uma degradação de 100% do fármaco Zidovudina, e formação de produtos de degradação. / Active Pharmaceuticals (AP) are considered as a new class of environmental organic micropollutant which are causing negative impact to the ecosystems. The pharmaceutical industries are one of the main responsible for this pollution leading to the search of new wastewater treatment methods. Among these pharmaceuticals, the Zidovudin (AZT) may be considered a pollutant of hard degradation profile by the conventional known methodologies and this problem motivated the development of a low cost electrochemical degradation method. The AT was donated by the Pernambuco State Pharmaceutical Laboratory (LAFEPE) and characterized by thermogravimetric analysis, infrared absorption spectroscopy and powder X-ray diffraction. The differential pulse voltammetry was first explored applying Hg amalgam and vitreous carbon electrodes, with and without Zn surface deposition. These conditions were tested at a H = 7.2 and pH = 9.6, using a 16 mm AZT in a sodium-phosphate buffer in order to identify and optimize the reduction peak. The results show that the AZT degrades when the amalgam and the vitreous carbon are applied. Searching for a less pollutant technique, the vitreous carbon electrode was chosen for the continuation of the studies. The optimized experimental conditions were found to be: 16 mm AZT in a sodium-phosphate buffer, with a current of I = 0.04 A, and 24 h reaction time. The High Performance Liquid Chromatography revealed 100% degradation for the AZT drug and the occurrence of degradation products. The present study shows the possibility of its use in the decontamination of the AZT industrial production wastewater.

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 (Ph.D.)--University of Minnesota, 1999. / Includes bibliographical references. Also available on the World Wide Web as a PDF file.

The success of scale up of antiretroviral therapy (ART) in low- and middle-income countries (LMICs) is in large part due to the introduction of a “public health approach” to access advocated by the World Health Organization (WHO) which emphasized standardized treatment regimens that could be purchased in large quantities and delivered at scale. In 2010 the WHO updated their global HIV treatment guidelines recommending the substitution of stavudine with tenofovir (both of which are members of the non-nucleoside reverse transcriptase inhibitor (NRTI) class of drugs) in first-line antiretroviral therapy (ART). Given the size of treatment programs in sub-Saharan Africa, changing the NRTI used in first-line therapy for HIV could have a substantial impact on treatment outcomes. We conducted three prospective cohort studies using clinical datasets from several sub-Saharan African countries to answer questions surrounding the impacts of exposure to tenofovir in first-line therapy. The first study examines the frequency of stavudine use and single-drug substitutions (substituting the NRTI in first-line ART) in three regions in sub-Saharan Africa by calendar year, 2004–2014. We found a total of 33,441 (8.9%; 95% CI: 8.7–8.9%) single-drug substitutions occurred among 377,656 patients in the first 24 months on ART, close to 40% of which were amongst patients on stavudine. The decrease in single-drug substitutions corresponded with the phasing out of stavudine. We saw an 80% reduction in the risk of single-drug substitutions when comparing tenofovir to stavudine and close to a 70% reduction in the risk when comparing zidovudine to stavudine. The second study uses a regression discontinuity design to evaluate the impact of national HIV treatment guideline changes in South Africa and Zambia recommending tenofovir in first-line ART on treatment outcomes. We found that updated WHO guidelines increased the proportion of patients initiating tenofovir (risk difference (RD) (South Africa): 81%; 95% CI: 73%, 89%; RD (Zambia): 42%; 95% CI: 38%, 45%). Intent to treat estimates showed a decrease in single-drug substitutions in South Africa (RD: -15%; 95% CI: -18%, -12%) and Zambia (RD: -2.0%; 95% CI: -3.6%, -0.3%). In both countries, there was no effect on mortality, attrition or viral load failure (South Africa only). The third study investigates the effect of the 2012 tenofovir stock shortage in South Africa on provider and patient level outcomes, using data from four public-sector Right to Care clinics, two of which experienced a tenofovir stock shortage and two that did not. While imprecise, our results suggest a potential shift in how providers managed patients during the period of the shortage, mainly, a noticeable decrease in the average number of days between visits during the shortage compare to before or after at all four clinics and a significant difference in the proportion of patients missing visits. Difference-in-difference regression results showed a small, but significant, increase in the risk of missed visits during the shortage compared to after (RD: 1.2%; 95% CI: 0.5%, 2.0%), mainly driven by ACTs clinic. No significant difference was seen in other outcomes. Great strides have been made to extend access to ART as well as increase the quality of the services provided to patients in sub-Saharan Africa. Continued access to and a consistent supply of tenofovir in this setting is necessary for patients to receive drugs that are comparable to those used for HIV treatment in high-income countries, as we show that phasing out of stavudine and for either zidovudine or tenofovir potentially reduced toxicities and potentially improved quality of life in multiple regions throughout sub-Saharan Africa. While we show little effect on treatment outcomes when comparing patients accessing care and treatment during the shortage of tenofovir compared to those that did not, this most likely reflects the clinics’ ability to offset the crisis by continuing to initiate newly diagnosed and eligible patients on treatment and keep treatment experienced patients on their current regimen.

Magister Pharmaceuticae - MPharm / Background: Zidovudine (AZT) is a very useful drug for the management of Human Immunodeficiency Virus (HIV) infection. Its optimal use is limited by its bitter taste, sparing solubility (20.1 mg/ml) and acid lability. Cyclodextrins (CD) are a class of compounds which can be used to form inclusion complexes with drugs such as AZT to improve it is taste, solubility and palatability. Purpose: This study complexed hydroxypropyl-beta-cyclodextrin (HPβCD) with AZT. The formulated inclusion complex was evaluated for suitability as a dosage form and as a tool for improving AZT’s palatability, solubility and acid liability. Method: AZT was complexed with HPβCD using the lyophilisation method. The binding constant for the formulation was determined by the phase solubility method, and complex formation between AZT and HPβCD evaluated using proton nuclear magnetic resonance (1H NMR), differential scanning calorimetry (DSC), thermogravimetric analysis (TGA) and hot stage microscopy (HSM). Tablets of the inclusion complex were formulated by direct compression, using the least possible amount of excipients, and the dosage form evaluated for hardness, friability, durability, disintegration time and dissolution. Results: The binding constant of the formulation was 3.919, and the degree of incorporation was 4.0 mg AZT/g of CD per complex. 1H NMR showed significant chemical shifts between the inclusion complex and AZT. DSC and TGA analyses showed significant differences in the curves for the pure AZT and HPβCD. Values for tablet hardness, friability, durability and disintegration time were 236 ± 20 N, 0.7 %, 1.02 % and 10.25 minutes, respectively. The solubility of the formulation was 148.08 mg/ml, and its dissolution profile was different from that of the branded formulation. Conclusions: AZT-HPβCD inclusion complex, with a 7.4-fold increase in AZT solubility, was successfully prepared using the lyophilisation method. The binding constant and friability of the formulation were within acceptable limits. Although the hardness value is high, the tablet still disintegrated within acceptable specified times. This study has significant implications for anti-retroviral complex formulations.

L’utilisation d’un traitement antirétroviral, chez la femme enceinte ou chez l’enfant infecté par le VIH, doit être optimale en termes d’efficacité et de tolérance. De nombreuses modifications physiologiques ont lieu tout au long de la grossesse ainsi que pendant les premières années de vie d’un enfant. Ces changements peuvent intervenir à tous les niveaux du devenir du médicament dans l’organisme. Une mauvaise connaissance des variations pharmacocinétiques associées à ces changements physiologiques peut amener à une toxicité ou à une inefficacité de ces traitements. Il est donc primordial de connaître la pharmacocinétique des différentes molécules antirétrovirales recommandées chez la femme enceinte et l’enfant infectés par le VIH. Les pharmacocinétiques de deux inhibiteurs non nucléosidiques de la transcriptase inverse, la zidovudine et l’abacavir et celle d'un inhibiteur de protéase, le lopinavir, ont été étudiées chez la femme enceinte et/ou chez l'enfant par une approche de population. L’évaluation et l’optimisation des recommandations posologiques de ces trois molécules ont été réalisées en tenant compte de relations concentration-effet et/ou concentration-toxicité précédemment établies. L'étude décrivant la pharmacocinétique de l’abacavir a montré qu’une adaptation posologique n’était pas nécessaire pendant la grossesse. En revanche, les études sur la pharmacocinétique de la zidovudine ont montré que les doses recommandées, chez la femme enceinte et chez l’enfant, devraient être diminuées afin de limiter les risques de toxicité. Pour finir, l’étude sur la pharmacocinétique du lopinavir a suggéré qu’il n’était pas nécessaire d’augmenter les posologies pendant la grossesse, contrairement à ce qui est recommandé dans la littérature. / The use of an antiretroviral therapy in pregnant women or in HIV-infected child should be optimal in terms of efficacy and safety. Important physiological changes occur during pregnancy and the first years of life. These changes can affect drug pharmacokinetics. Poor knowledge of pharmacokinetic variations associated with these physiological changes can lead to toxicity or failure of these treatments. Therefore, it is important to know the antiretroviral pharmacokinetics of recommended drugs in pregnant women and in HIV-infected children. The pharmacokinetics of two nucleoside reverse transcriptase inhibitors, zidovudine and abacavir and one protease inhibitor, lopinavir, have been studied in pregnant women and/or in children with a population approach. The evaluation and optimization of dosage recommendations of these three molecules have been achieved using concentration-efficacy and/or concentration-toxicity relationships previously established. The study describing the abacavir pharmacokinetics showed that a dose adjustment was not necessary during pregnancy. However, studies on zidovudine pharmacokinetics presented that the doses recommended in pregnant women and in children should be reduced in order to limit the toxicity risks. Finally, the study on lopinavir pharmacokinetics suggested not to increase the lopinavir dosage during pregnancy contrary to the recommendations of previous studies.

A síndrome da imunodeficiência adquirida é causada pelo vírus da imunodeficiência humana e é caracterizada por provocar depleção física e funcional do sistema imune do organismo, através da infecção citopática de células CD4+. Muitos fármacos anti-retrovirais tem sido desenvolvidos e estão disponíveis comercialmente. Para atuar no controle de qualidade de medicamentos deve-se continuamente estudar o desenvolvimento e a validação de novas metodologias para quantificação de fármacos, para serem aplicadas nos estudos de estabilidade de formulações farmacêuticas e na análise de produtos de degradação. Neste trabalho foram utilizadas duas técnicas analíticas, a espectrofotometria direta no UV/VIS e a cromatografia líquida de alta eficiência (CLAE), para a determinação quantitativa de zidovudina (AZT) e estavudina (d4T).em medicamentos. Ambos os métodos foram validados com relação à linearidade, exatidão, precisão, especificidade e limite de detecção e quantificação. O método validado para a CLAE foi também empregado para a determinação quantitativa da timina, produto de degradação do AZT e da d4T. A metodologia validada por CLAE foi utilizada na realização de estudos de estabilidade acelerada dos anti-retrovirais contidos nas diferentes preparações farmacêuticas. Realizou-se o estudo da estabilidade em três diferentes condições: temperatura ambiente, 40 oC / 75% UR e 50 oC / 90% UR. Tanto a zidovudina (Fabricante A) e estavudina (Fabricante B) apresentaram decaimento cinético de zero ordem com prazos de validade a 50 oC / 90% UR de 10, 3 e 2 meses, respectivamente. / The acquired immunodeficiency syndrome is characterized by causing physical and functional depletion of the organism’s immune system, through the cytophatic infection of CD4+ cells. Several antiretroviral drugs has been developed and commercially made available. In order to assure the quality control of drugs it is necessary to develop and validate new analytical methodologies to perform the quantitative determination of drugs and stability studies of pharmaceutical formulations by determining the drug itself and its degradation products. In this research two analytical techniques, direct UV/VIS spectrophotometry and high performance liquid chromatography (HPLC), were used for the quantitative determination of zidovudine (AZT) and stavudine (d4T) in pharmaceutical preparations. Both methods were validated and parameters like linearity, precision, accuracy, specificity, limit of detection and limit of quantification, were determined. The validated HPLC method was also applied for quantitative determination of timine, a degradation product of AZT and d4T. The validated HPLC method was applied to accelerate stability studies of AZT and d4T in different pharmaceutical preparations. The stability studies were performed at three different conditions: room temperature, 40 oC / 75% RH and 50 oC / 90% RH. Both AZT and d4T (Industry A) and d4T (Industry B) pharmaceutical preparations presented a zero order degradation reaction. The three formulations presented a shelf-life of 10, 3 and 2 months, respectively, at 50 oC / 90% RH.

A síndrome da imunodeficiência adquirida é causada pelo vírus da imunodeficiência humana e é caracterizada por provocar depleção física e funcional do sistema imune do organismo, através da infecção citopática de células CD4+. Muitos fármacos anti-retrovirais tem sido desenvolvidos e estão disponíveis comercialmente. Para atuar no controle de qualidade de medicamentos deve-se continuamente estudar o desenvolvimento e a validação de novas metodologias para quantificação de fármacos, para serem aplicadas nos estudos de estabilidade de formulações farmacêuticas e na análise de produtos de degradação. Neste trabalho foram utilizadas duas técnicas analíticas, a espectrofotometria direta no UV/VIS e a cromatografia líquida de alta eficiência (CLAE), para a determinação quantitativa de zidovudina (AZT) e estavudina (d4T).em medicamentos. Ambos os métodos foram validados com relação à linearidade, exatidão, precisão, especificidade e limite de detecção e quantificação. O método validado para a CLAE foi também empregado para a determinação quantitativa da timina, produto de degradação do AZT e da d4T. A metodologia validada por CLAE foi utilizada na realização de estudos de estabilidade acelerada dos anti-retrovirais contidos nas diferentes preparações farmacêuticas. Realizou-se o estudo da estabilidade em três diferentes condições: temperatura ambiente, 40 oC / 75% UR e 50 oC / 90% UR. Tanto a zidovudina (Fabricante A) e estavudina (Fabricante B) apresentaram decaimento cinético de zero ordem com prazos de validade a 50 oC / 90% UR de 10, 3 e 2 meses, respectivamente. / The acquired immunodeficiency syndrome is characterized by causing physical and functional depletion of the organism’s immune system, through the cytophatic infection of CD4+ cells. Several antiretroviral drugs has been developed and commercially made available. In order to assure the quality control of drugs it is necessary to develop and validate new analytical methodologies to perform the quantitative determination of drugs and stability studies of pharmaceutical formulations by determining the drug itself and its degradation products. In this research two analytical techniques, direct UV/VIS spectrophotometry and high performance liquid chromatography (HPLC), were used for the quantitative determination of zidovudine (AZT) and stavudine (d4T) in pharmaceutical preparations. Both methods were validated and parameters like linearity, precision, accuracy, specificity, limit of detection and limit of quantification, were determined. The validated HPLC method was also applied for quantitative determination of timine, a degradation product of AZT and d4T. The validated HPLC method was applied to accelerate stability studies of AZT and d4T in different pharmaceutical preparations. The stability studies were performed at three different conditions: room temperature, 40 oC / 75% RH and 50 oC / 90% RH. Both AZT and d4T (Industry A) and d4T (Industry B) pharmaceutical preparations presented a zero order degradation reaction. The three formulations presented a shelf-life of 10, 3 and 2 months, respectively, at 50 oC / 90% RH.