ABSTRACT
Plasma concentrations of antiretrovirals are significant and important determinants of treatment failure and toxicity. The relationship between antiretroviral pharmacokinetic exposures and immunovirological outcomes has not been extensively studied in our setting. The aim of this study was to investigate the relationship between antiretroviral plasma concentrations and virological and immunological treatment outcomes in children living with human immunodeficiency virus (HIV) A retrospective collection of demographic, clinical , laboratory data and a prospective determination of plasma drug concentrations in 120 children aged 2-14 years after two years of receiving fixed dose zidovudine, lamivudine and nevirapine tablets using a simple, rapid, sensitive and validated method of high performance liquid chromatography with UV detection for simultaneous quantification of zidovudine, lamivudine and nevirapine in human plasma. All analyses were performed using graph pad prism version 5.0. A perfect agreement (p<.001) was found between nevirapine drug levels and prescriptionrefill visit adherence records (Kappa 0.093). Plasma zidovudine, lamivudine and nevirapine concentrations were not statistically associated with virological success (Viral load <400copies/µl ) and immunological success (CD4 cells >100 cells/mm3). At 2 years zidovudine, lamivudine and nevirapine therapeutic levels, zidovudine supra therapeutic levels ,and nevirapine subtherapeutic levels were respectively significantly associated with immunologic success (CD4%>15 %). Low nevirapine levels can be used to identify those that require adherence counseling. Despite good virological and immunological outcomes, plasma concentrations of zidovudine, lamivudine and nevirapine were not significantly associated with virological and immunological outcomes (Absolute CD4 counts) but was significantly associated with immunological outcomes (CD4%). Plasma drug levels may be good surrogates of adherence but not of treatment outcomes. Monitoring CD4% remains important to optimize paediatric HIV treatment
Subject(s)
Anti-Retroviral Agents , NigeriaABSTRACT
The main aim of this work was to study the effect of ascorbic acid on the efficacy of artemether against plasmodium berghei infected mice. The study was divided into 2 phases and a total of 40 Swiss albino wistars mice of average weight 20g were used in all, 10 for phase 1 and the remaining 30 for phase 2. The phase 1 was mainly to determine the peak parasitaemia in order to estimate the day to commence drug treatment in phase 2. In phase 2 of the study, the mice were divided into 6 treatment groups: artemether alone, artemether with low dose ascorbic acid, artemether with high dose ascorbic acid, low dose ascorbic acid alone, high dose ascorbic acid alone and the control group. The study showed that ascorbic acid, in high dose antagonized the antiplasmodial effect of artemether. Average % suppression in parasitaemia was found to be 51.4±32.21 as against that observed for artemether alone at 60.3±18.70. The study also showed that high ascorbic acid can slow down the rate of development of malarial parasitaemia in infected mice and these results were found to be statistically significant. In conclusion, coadministration of ascorbic acid may reduce the antimalarial potency of artemether, an artemisinin derivative and high dose of ascorbic acid may also suppress parasite growth.