ABSTRACT
Human Immunodeficiency Virus Type 1 exists in vivo as quasispecies, and one of the genome's characteristics is its diversity. During the antiretroviral therapy, drug resistance is the main obstacle to effective viral prevention. Understanding the molecular evolution process is fundamental to analyze the mechanism of drug resistance and develop a strategy to minimize resistance. Objective: The molecular evolution of drug resistance of one patient who had received reverse transcriptase inhibitors for a long time and had treatment which replaced Nevirapine with Indinavir was analyzed, with the aim of observing the drug resistance evolution pathway. Methods: The patient, XLF, was followed-up for six successive times. The viral populations were amplified and sequenced by single-genome amplification. All the sequences were submitted to the Stanford HIV Drug Resistance Database for the analysis of genotypic drug resistance. Results: 149 entire protease and 171 entire reverse transcriptase sequences were obtained from these samples, and all sequences were identified as subtype B. Before the patient received Indinavir, the viral population only had some polymorphisms in the protease sequences. After the patient began Indinavir treatment, the variants carrying polymorphisms declined while variants carrying the secondary mutation G73S gained the advantage. As therapy was prolonged, G73S was combined with M46I/L90M to form a resistance pattern M46I/G73S/L90M, which then became the dominant population. 97.9% of variants had the M46I/G73S/L90M pattern at XLF6. During the emergence of protease inhibitors resistance, reverse transcriptase inhibitors resistance maintained high levels. Conclusion: Indinavir- resistance evolution was observed by single-genome amplification. During the course of changing the regimen to incorporate Indinavir, the G73S mutation occurred and was combined with M46I/L90M.
ABSTRACT
This case reported to a patient with AIDS who presented persistent sterile leukocyturia and hematuria, lower back pain, bladder suffering symptoms, and renal papillary necrosis which were thought to be secondary to urinary tuberculosis but were demonstrated to be indinavir-associated side effects. The intention of this report is to remind medical professionals involved in the care of HIV+ patients of this possible association in order to avoid unnecessary investigation and to stress the need of careful periodical assessment of renal function and urinalysis in patients treated with indinavir.
Subject(s)
Humans , Male , Middle Aged , Acquired Immunodeficiency Syndrome/drug therapy , HIV Protease Inhibitors/adverse effects , Indinavir/adverse effects , Kidney Papillary Necrosis/chemically induced , Kidney Papillary Necrosis/diagnosis , Tuberculosis, Urogenital/diagnosis , Diagnosis, Differential , Glomerular Filtration RateABSTRACT
We report the development and validation of a new sensitive, accurate and precise HPLC method with ultraviolet detection for the determination of indinavir sulfate (IND) in human plasma and its application to a bioequivalence study of a new generic formulation. The extraction of IND from plasma samples was achieved by using liquid-liquid extraction with a mean recovery of 73.9 percent. The lower limit of quantification was 0.05 µg/mL. Bioequivalence between the products was determined by calculating 90 percent confidence intervals (CI) for the ratio of Cmax, AUC0-t and AUC0-inf values for the test and reference products, within the 0.80-1.25 interval proposed by ANVISA and FDA. Therefore the medications are bioequivalent and inter-exchangeable.
Foi desenvolvido e validado um novo método, sensível, exato e preciso por Cromatografia a Líquido de Alta Eficiência com detecção em UV para a determinação do sulfato de indinavir (IND) em plasma humano. O fármaco foi extraído do plasma através de extração líquido-líquido obtendo recuperação média de 73.9 por cento, com limite inferior de quantificação de 0.05 µg/mL. O método foi aplicado em estudo de farmacocinética para verificar a bioequivalência entre um novo medicamento genérico e seu produto de referência. A bioequivalência entre os produtos foi determinada calculando-se um intervalo de confiança (IC) de 90 por cento para a razão das médias do produto teste e referência compreendidas entre o intervalo de 0.80-1.25 proposto pela ANVISA e O FDA. Os produtos estudados são bioequivalentes e, portanto, intercambiáveis.
Subject(s)
Indinavir/pharmacokinetics , Plasma/metabolism , Chromatography, Liquid/methods , Therapeutic EquivalencyABSTRACT
O sulfato de indinavir é um inibidor da protease no ciclo do vírus da imunodeficiência humana (HIV). O objetivo deste trabalho foi o desenvolvimento da formulação, desenvolvimento e avaliação da metodologia para dissolução, estudo micromerítico, transposição de escala industrial, estudo de estabilidade e estudo comparativo para cápsulas de sulfato de indinavir 500 mg (equivalente a 400 mg de indinavir). Para o desenvolvimento farmacotécnico, realizou-se uma planificação qualitativa de diluentes. As metodologias analíticas para peso médio, desintegração, umidade e uniformidade de peso, seguiram The United States Pharmacopeia 28, enquanto que a metodologia utilizada para dissolução foi desenvolvida e avaliada atendendo à Resolução RE nº 899, de 29 de maio de 2003, da Agência Nacional de Vigilância Sanitária (ANVISA). Os resultados demonstraram que a formulação selecionada correspondeu às especificações de controle físico-químico, além de apresentar viabilidade econômica. Os resultados obtidos com o desenvolvimento e avaliação do método para dissolução mostram que o método atende aos requisitos de Boas Práticas de Fabricação e Controle, pois apresentam a reprodutibilidade, a precisão, a robustez e finalmente a confiabilidade requerida para um método analítico. As cápsulas desenvolvidas de sulfato de indinavir, quando comparadas com o medicamento de referência, são equivalentes entre si, frente a diferentes parâmetros avaliados.
Indinavir sulfate is a protease inhibitor in the cycle of the human immunodeficiency virus (HIV). The purpose of this study was the development of formulation, and its evaluation methodology for dissolution, rheological study, scale transposition, stability study and comparative study for indinavir sulfate 500 mg capsules (equivalent to 400 mg of indinavir). A qualitative design of diluents has been performed for the pharmaceutics development. The analytical methodologies for medium weight, disintegration, humidity and uniformity of weight followed The United States Pharmacopeia 28, while the methodology used for dissolution was developed and evaluated in accordance with Resolution RE nº 899, as of May 29, 2003, issued by the Agência Nacional de Vigilância Sanitária [National Agency for Sanitary Surveillance] (ANVISA). The results have evidenced that the selected formulation corresponds to the specifications of physical-chemical control, besides showing its economic feasibility. The results obtained from the development and evaluation of dissolution method have evidenced that the method complies with the requirements of Good Manufacturing and Control Practices, since it shows the reproducibility, the precision, the robustness and finally the reliability required for an analytical method. The developed indinavir sulfate capsules, when compared with the reference drug, are equivalent, in the light of different evaluated parameters.
Subject(s)
HIV , Indinavir/pharmacokinetics , Sulfates , Chemistry, Pharmaceutical , Drug Stability , Dissolution/methodsABSTRACT
AIM: To establish a method to determine the concentration of indinavir in human plasma and study indinavir bioavailability in Chinese healthy people. METHODS: In a random two-period crossover study, 18 healthy male volunteers received a single dose of indinavir capsules 800 mg of two formulations respectively.A sensitive and specific reversed phase HPLC method was developed to quantitate plasma levels of indinavir. The drug was extracted from plasma with acetonitrile. Analysis was performed on a Hy persil C18 column with a mobile phase of acetonitrile:0.01 mol · L -1 phosphate buffer(pH 5.5 ) (43: 57).The UV detector was set at 210 nm. The standard curve covered the concentration ranged from 0. 03 to 16.38 mg · L-1. RESULTS: The concentration-time curves of reference and tested formulations both fitted to a one-compartment open model. The main pharmacokinetic rameters of tested and reference formulations were (10.6 ±s 2.4) mg· L-1 and (9.8 ±2.2)mg· L-1 for cmax, (0. 71 ± 0. 19) h and (0. 8 ±0.3) h for tmax, (1.30±0.24) h and (1.31 ±0.23) h for t1/2ke, (23±6) mg·h· L-1 and (22±5) mg·h · L-1 forAUC0-10, (24±6) mg · h · L-1 and (22±5) mg · h · L-1 for AUC0-∞, respectively. Two one-sidet test and variance analysis were performed in bioequivalent assessment. No statistically significant difference was found in AUC0-10, AUC0-∞ and cmax values between the tested and reference formulations. CONCLUSION:The reversed phase HPLC is a reliable method to determine the concentration of indinavir in human plasma and the two formulations of indinavir are bioequivalent.
ABSTRACT
0.05)in the main pharmacokinetic parameters between the domestic preparation and the imported preparation,which suggests they are bioequivalent.
ABSTRACT
O sulfato de indinavir, em associação com inibidofores d transcripfase reversa, promove, de forma efetiva, aumento da contagem de células CD4+ e redução da carga viral (ARN-VIH) em pacientes com sindrome de imunodeficiência adquirida. Esse inibidor da protease provoca nefrolitiase em até 34,4% dos pacientes. Em decorrência do uso ainda freqüente deste antiretroviral, seus efeitos adversos devem ser prontamente reconhecidos e prevenidos, quando possível. Este trabalho descreve a associação de litíase urinária com manifestações clínicas exuberantes com o uso de indinavir.
A case of nephrolithiasis related to the use of indinavir sulfate is described. This drug, in association with reverse transcriptase inhibitors, effectively promotes a rise in the CD4+ T cell count and a decrease in the levels of HIV RNA in AIDS patients. This protease inhibitor elicits the development of nephrolithiasis in up to 34.4% of patients. Since indinavir sulfate is a frequently prescribed drug, its side effects should be well known and avoided whencver possibie.