Multipurpose Tenofovir Disoproxil Fumarate Electrospun Fibers for the Prevention of HIV-1 and HSV-2 Infections

Total Page:16

File Type:pdf, Size:1020Kb

Multipurpose Tenofovir Disoproxil Fumarate Electrospun Fibers for the Prevention of HIV-1 and HSV-2 Infections University of Louisville ThinkIR: The University of Louisville's Institutional Repository Electronic Theses and Dissertations 8-2016 Multipurpose tenofovir disoproxil fumarate electrospun fibers for the prevention of HIV-1 and HSV-2 infections. Kevin Tyo Follow this and additional works at: https://ir.library.louisville.edu/etd Part of the Other Chemicals and Drugs Commons, Polymer Chemistry Commons, Preventive Medicine Commons, and the Virus Diseases Commons Recommended Citation Tyo, Kevin, "Multipurpose tenofovir disoproxil fumarate electrospun fibers for the prevention of HIV-1 and HSV-2 infections." (2016). Electronic Theses and Dissertations. Paper 2486. https://doi.org/10.18297/etd/2486 This Master's Thesis is brought to you for free and open access by ThinkIR: The University of Louisville's Institutional Repository. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of ThinkIR: The University of Louisville's Institutional Repository. This title appears here courtesy of the author, who has retained all other copyrights. For more information, please contact [email protected]. MULTIPURPOSE TENOFOVIR DISOPROXIL FUMARATE ELECTROSPUN FIBERS FOR THE PREVENTION OF HIV-1 AND HSV-2 INFECTIONS By Kevin Tyo B.S. Virginia Tech, 2010 A Thesis Submitted to the Faculty of the School of Medicine of the University of Louisville In Partial Fulfillment of the Requirement for the Degree of Master of Science In Pharmacology and Toxicology Department of Pharmacology and Toxicology School of Medicine University of Louisville Louisville, KY August, 2016 MULTIPURPOSE TENOFOVIR DISOPROXIL FUMARATE ELECTROSPUN FIBERS FOR THE PREVENTION OF HIV-1 AND HSV-2 INFECTIONS By Kevin Tyo B.S. Virginia Tech, 2010 Thesis approved on By the following Thesis Committee: Dr. Jill Steinbach-Rankins Dr. Gavin Arteel Dr. Hermann Frieboes Dr. Nobuyuki Matoba Dr. Kenneth Palmer ii DEDICATION To my Grandmother Teruko Reynolds iii ACKNOWLEDGEMENTS I would like to acknowledge and give thanks to my mentor Dr. Jill Steinbach-Rankins. She has continuously offered support and guidance to both me and my scientific research. Despite my occasional failures, she has never wavered in her support. Additionally, I would like to acknowledge the additional support given from my fellow lab members as well as colleagues in the Department of Pharmacology and Toxicology. iv ABSTRACT MULTIPURPOSE TENOFOVIR DISOPROXIL FUMARATE ELECTROSPUN FIBERS FOR THE PREVENTION OF HIV-1 AND HSV-2 INFECTIONS Kevin Tyo Sexually transmitted infections affect hundreds of millions of worldwide. Both human immunodeficiency virus (HIV-1 and -2) and herpes simplex virus-2 (HSV- 2) remain incurable, urging the development of new prevention strategies. While current prophylactic technologies are dependent on strict user adherence to achieve efficacy, there is a dearth of delivery vehicles that provide discreet and convenient administration, combined with prolonged-delivery of active agents. To address these needs, we created electrospun fibers (EFs) comprised of FDA- approved polymers, poly(lactic-co-glycolic acid) (PLGA) and poly(DL-lactide-co- ε-caprolactone) (PLCL), to provide sustained-release and in vitro protection against HIV-1 and HSV-2. PLGA and PLCL EFs, incorporating the antiretroviral, tenofovir disoproxil fumarate (TDF), exhibited sustained-release for up to 4 weeks, and provided complete in vitro protection against HSV-2 and HIV-1 for 24 hr and 2 wk, respectively. In vitro tests confirmed the safety of these fibers in vaginal and cervical cells, highlighting the potential of polymeric EFs as multipurpose next-generation drug delivery vehicles. v TABLE OF CONTENTS PAGE DEDICATION ....................................................................................................... iii ACKNOWLEDGEMENTS ..................................................................................... iv ABSTRACT ......................................................................................................... v LIST OF TABLES ............................................................................................... vii LIST OF FIGURES ............................................................................................ viii BACKGROUND AND INTRODUCTION .............................................................. 1 CURRENT HIV AND HSV-2 THERAPEUTICS ................................................... 6 ORAL AND TOPICAL PrEP ................................................................................. 9 ELECTROSPUN FIBERS .................................................................................. 13 METHODS AND MATERIALS ........................................................................... 19 RESULTS .......................................................................................................... 27 DISCUSSION .................................................................................................... 56 SUMMARY AND CONCLUSIONS .................................................................... 67 REFERENCES .................................................................................................. 69 CURRICULUM VITAE ....................................................................................... 74 vi LIST OF TABLES PAGE 1. Quantification of TDF fiber loading and encapsulation efficiency ................... 35 2. PLGA and PLCL fiber IC50s (against HIV-1) after administration of the 1 and 24 hr eluates ...................................................................................................... 44 3. PLGA and PLCL fiber IC50s (against HIV-1) after administration of the 1, and 2 wk eluates ..................................................................................................... 47 4. PLGA and PLCL fiber IC50s (against HSV-2) after administration of the 1 and 24 hr eluates ...................................................................................................... 52 vii LIST OF FIGURES PAGE 1. A heat map depicting the prevalence of HIV infection ..................................... 3 2. Chemical structure of PLGA and PCL ............................................................ 15 3. Structure of Tenofovir Disoproxil Fumarate (TDF) ......................................... 18 4. Scanning electron microscopy images (SEM) of blank PLGA and PLCL fibers electrospun using different solvents .................................................................. 29 5. SEM images of PLGA and PLCL fibers prepared with increasing concentrations of TDF (1%, 10%, 20% w/w) using HFIP as solvent .................. 30 6. Average diameters of electrospun fibers measured from SEM images using Image J .............................................................................................................. 31 7. TDF standard curve for loading and encapsulation efficiency.........................36 8. TDF standard curve used to assess sustained release...................................37 9. Sustained-release profile of TDF fibers in SVF .............................................. 38 10. Results from in vitro HIV-1 infection assays ................................................ 42 11. Results from in vitro HSV-2 infection assays ............................................... 50 12. IC50 curve of HSV-2 plaque assay inhibition ................................................ 51 viii 13. Representative pictures from HSV-2 plaque assays using undiluted fiber eluates ............................................................................................................... 53 14. Cytotoxicity assessed via MTT assay ........................................................... 55 iii BACKGROUND AND INTRODUCTION Sexually transmitted infections (STIs) are a global health challenge, with over one million new cases of STIs reported daily. Over 530 and 36 million people globally are infected by herpes simplex virus type-2 (HSV-2) and human immunodeficiency virus (HIV), respectively [1]. Compounding these statistics, HSV-2 infection has been shown to significantly enhance HIV infection by as much as 2 to 7-fold [2, 3]. Furthermore, co-infected individuals harbor higher concentrations of both viruses relative to individuals with only one infection [3]. Despite the existence of multiple strategies to prevent STIs, no cure exists for these diseases, and rates of infection among particular demographics remain high [4, 5]. The first known incidence of HIV infection originated in the late 1950s in what is today known as the Democratic Republic of the Congo [6]. The general consensus of scientists is that HIV originated from cross-species contamination of simian immunodeficiency viruses (SIVs), which normally infect primates. The first known cases of the current HIV pandemic in the United States date back to 1981, where previously healthy homosexual men began suffering and dying from opportunistic infections [7]. At first this emerging disease, designated Acquired Immune Deficiency Syndrome (AIDS) was widely believed to only affect homosexuals. However, in 1984 it was discovered that AIDs is caused by the HIV, which is transmitted by hetero- and homosexual intercourse, blood-to-blood 1 transmission, or mucosal exposure [8]. Today, over 36 million people worldwide carry the virus, with women in the developing world bearing the highest burden of infection (Figure 1). Currently, there two types of HIV known: HIV-1 and HIV-2, with HIV-1 being more prevalent due to higher virulence
Recommended publications
  • COVID-19) Pandemic on National Antimicrobial Consumption in Jordan
    antibiotics Article An Assessment of the Impact of Coronavirus Disease (COVID-19) Pandemic on National Antimicrobial Consumption in Jordan Sayer Al-Azzam 1, Nizar Mahmoud Mhaidat 1, Hayaa A. Banat 2, Mohammad Alfaour 2, Dana Samih Ahmad 2, Arno Muller 3, Adi Al-Nuseirat 4 , Elizabeth A. Lattyak 5, Barbara R. Conway 6,7 and Mamoon A. Aldeyab 6,* 1 Clinical Pharmacy Department, Jordan University of Science and Technology, Irbid 22110, Jordan; [email protected] (S.A.-A.); [email protected] (N.M.M.) 2 Jordan Food and Drug Administration (JFDA), Amman 11181, Jordan; [email protected] (H.A.B.); [email protected] (M.A.); [email protected] (D.S.A.) 3 Antimicrobial Resistance Division, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland; [email protected] 4 World Health Organization Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt; [email protected] 5 Scientific Computing Associates Corp., River Forest, IL 60305, USA; [email protected] 6 Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK; [email protected] 7 Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield HD1 3DH, UK * Correspondence: [email protected] Citation: Al-Azzam, S.; Mhaidat, N.M.; Banat, H.A.; Alfaour, M.; Abstract: Coronavirus disease 2019 (COVID-19) has overlapping clinical characteristics with bacterial Ahmad, D.S.; Muller, A.; Al-Nuseirat, respiratory tract infection, leading to the prescription of potentially unnecessary antibiotics. This A.; Lattyak, E.A.; Conway, B.R.; study aimed at measuring changes and patterns of national antimicrobial use for one year preceding Aldeyab, M.A.
    [Show full text]
  • Which Drugs Are Most Effective for Recurrent Herpes Labialis?
    Evidence-based answers from the clinical inquiries Family Physicians Inquiries Network Eiko Tubridy, MD; Gary Kelsberg, MD Valley Family Residency Which drugs are most Program, Renton, Wash Leilani St Anna, MLIS, effective for recurrent AHIP University of Washington Health Sciences Libraries, herpes labialis? Seattle AssistanT EDITOR EvidEncE-basEd answEr Jon O. neher, MD Valley Family Residency daily oral acyclovir or vala- ing to the agent used: valacyclovir reduces Program, Renton, Wash A cyclovir may help prevent her- both healing time and duration of pain, pes simplex labialis (HSL) recurrences famciclovir reduces both in one dosage (strength of recommendation [SOR]: B, form but not another, and acyclovir reduces meta-analysis of randomized controlled only pain duration (SOR: B, single RCTs). trials [RCTs] with heterogeneous results). Several topical medications (acyclovir, No trials compare oral or topical treat- penciclovir, docosanol) modestly decrease ments for HSL outbreaks against each oth- healing time and pain duration—typically er. Oral antivirals modestly reduce healing by less than a day—and require multiple time and duration of pain, varying accord- doses per day (SOR: B, multiple RCTs). Evidence summary The authors of the meta-analysis noted A systematic review and meta-analysis of the that although 9 studies favored the use of an effectiveness of oral and topical nucleoside antiviral drug, only 4 showed statistically sig- antiviral agents to prevent recurrent HSL in nificant differences when compared with pla- immunocompetent people found 11 RCTs cebo, and none of them had a low risk of bias. with a total of 1250 patients that compared They concluded that the review supported us- an active drug against placebo.1 The medi- ing oral acyclovir and valacyclovir to prevent cations were topical 5% acyclovir, topical 1% recurrent HSL.1 penciclovir, and oral acyclovir, valacyclovir, or famciclovir in various doses.
    [Show full text]
  • Prediction of Premature Termination Codon Suppressing Compounds for Treatment of Duchenne Muscular Dystrophy Using Machine Learning
    Prediction of Premature Termination Codon Suppressing Compounds for Treatment of Duchenne Muscular Dystrophy using Machine Learning Kate Wang et al. Supplemental Table S1. Drugs selected by Pharmacophore-based, ML-based and DL- based search in the FDA-approved drugs database Pharmacophore WEKA TF 1-Palmitoyl-2-oleoyl-sn-glycero-3- 5-O-phosphono-alpha-D- (phospho-rac-(1-glycerol)) ribofuranosyl diphosphate Acarbose Amikacin Acetylcarnitine Acetarsol Arbutamine Acetylcholine Adenosine Aldehydo-N-Acetyl-D- Benserazide Acyclovir Glucosamine Bisoprolol Adefovir dipivoxil Alendronic acid Brivudine Alfentanil Alginic acid Cefamandole Alitretinoin alpha-Arbutin Cefdinir Azithromycin Amikacin Cefixime Balsalazide Amiloride Cefonicid Bethanechol Arbutin Ceforanide Bicalutamide Ascorbic acid calcium salt Cefotetan Calcium glubionate Auranofin Ceftibuten Cangrelor Azacitidine Ceftolozane Capecitabine Benserazide Cerivastatin Carbamoylcholine Besifloxacin Chlortetracycline Carisoprodol beta-L-fructofuranose Cilastatin Chlorobutanol Bictegravir Citicoline Cidofovir Bismuth subgallate Cladribine Clodronic acid Bleomycin Clarithromycin Colistimethate Bortezomib Clindamycin Cyclandelate Bromotheophylline Clofarabine Dexpanthenol Calcium threonate Cromoglicic acid Edoxudine Capecitabine Demeclocycline Elbasvir Capreomycin Diaminopropanol tetraacetic acid Erdosteine Carbidopa Diazolidinylurea Ethchlorvynol Carbocisteine Dibekacin Ethinamate Carboplatin Dinoprostone Famotidine Cefotetan Dipyridamole Fidaxomicin Chlormerodrin Doripenem Flavin adenine dinucleotide
    [Show full text]
  • Tall Man Lettering List REPORT DECEMBER 2013 1
    Tall Man Lettering List REPORT DECEMBER 2013 1 TALL MAN LETTERING LIST REPORT WWW.HQSC.GOVT.NZ Published in December 2013 by the Health Quality & Safety Commission. This document is available on the Health Quality & Safety Commission website, www.hqsc.govt.nz ISBN: 978-0-478-38555-7 (online) Citation: Health Quality & Safety Commission. 2013. Tall Man Lettering List Report. Wellington: Health Quality & Safety Commission. Crown copyright ©. This copyright work is licensed under the Creative Commons Attribution-No Derivative Works 3.0 New Zealand licence. In essence, you are free to copy and distribute the work (including other media and formats), as long as you attribute the work to the Health Quality & Safety Commission. The work must not be adapted and other licence terms must be abided. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nd/3.0/nz/ Copyright enquiries If you are in doubt as to whether a proposed use is covered by this licence, please contact: National Medication Safety Programme Team Health Quality & Safety Commission PO Box 25496 Wellington 6146 ACKNOWLEDGEMENTS The Health Quality & Safety Commission acknowledges the following for their assistance in producing the New Zealand Tall Man lettering list: • The Australian Commission on Safety and Quality in Health Care for advice and support in allowing its original work to be either reproduced in whole or altered in part for New Zealand as per its copyright1 • The Medication Safety and Quality Program of Clinical Excellence Commission, New South
    [Show full text]
  • Drug Prescribing for Dentistry Dental Clinical Guidance
    Scottish Dental Clinical Effectiveness Programme SDcep Drug Prescribing For Dentistry Dental Clinical Guidance Second Edition August 2011 Scottish Dental Clinical Effectiveness Programme SDcep The Scottish Dental Clinical Effectiveness Programme (SDCEP) is an initiative of the National Dental Advisory Committee (NDAC) and is supported by the Scottish Government and NHS Education for Scotland. The programme aims to provide user-friendly, evidence-based guidance for the dental profession in Scotland. SDCEP guidance is designed to help the dental team provide improved care for patients by bringing together, in a structured manner, the best available information that is relevant to priority areas in dentistry, and presenting this information in a form that can interpreted easily and implemented. ‘Supporting the dental team to provide quality patient care’ Scottish Dental Clinical Effectiveness Programme SDcep Drug Prescribing For Dentistry Dental Clinical Guidance Second Edition August 2011 Drug Prescribing For Dentistry © Scottish Dental Clinical Effectiveness Programme SDCEP operates within NHS Education for Scotland. You may copy or reproduce the information in this document for use within NHS Scotland and for non-commercial educational purposes. Use of this document for commercial purpose is permitted only with written permission. ISBN 978 1 905829 13 2 First published 2008 Second edition published August 2011 Scottish Dental Clinical Effectiveness Programme Dundee Dental Education Centre, Frankland Building, Small’s Wynd, Dundee DD1
    [Show full text]
  • Efficacy and Safety of Imiquimod for Verruca Planae: a Systematic Review
    Global Dermatology Research Article ISSN: 2056-7863 Efficacy and safety of imiquimod for verruca planae: A systematic review Xin-rui Zhang#, Bi-huan Xiao#, Rui-qun Qi*, and Xing-hua Gao* Department of Dermatology, No 1 Hospital of China Medical University, Shenyang 110001, PR China #These authors contributed equally to this work Abstract Objective: To assess the efficacy and safety of imiquimod for treating verruca planae. Methods: We searched the Pubmed, Cochrane Register of Controlled Trials, EMbase, CBM, CNKI and Wanfang databases (Chinese) to collect randomized controlled trials (RCTs). We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of include studies, and performed meta-analyses using the Cochrane Collaboration’s RevMan 5.1. Software. Results: Twenty-six RCTs involving 2169 patients with verruca planae were included and assessed. At the end of the 6th and ≥8th week, the effective rate of topical imiquimod was obviously higher than that of control [ RR=1.42, 95%CI (1.27, 1.60), P <0.00001; RR=1.43, 95%CI (1.22,1.67), P<0.00001]. The effective rate of imiquimod cream was higher than tretinoin cream, tazarotene gel and other antiviral drugs. [RR=1.41, 95%CI (1.25, 1.59), P <0.00001; RR=1.76, 95%CI (1.48, 2.10), P<0.00001; RR=1.71, 95%CI (1.29, 2.26), P =0.0002]. However, the effectiverate of imiquimod cream was lower than 5-ALA-PDT (RR=0.6, 95%CI (0.5, 0.71), P<0.00001). Conclusions: The limited evidence demonstrates that topical imiquimod is safe and efficient.
    [Show full text]
  • Treating the Oral Creeper: Herpes
    ISSN: 2574-1241 Volume 5- Issue 4: 2018 DOI: 10.26717/BJSTR.2018.08.001639 Karthik D Yadav. Biomed J Sci & Tech Res Short Communication Open Access Treating the Oral Creeper: Herpes Yadav Karthik D1*, Pai Anuradha2, R Shesha Prasad3, Yaji Anisha4 1M.D.S - Master of Dental surgery, Department of oral medicine and radiology, Bangalore 2HOD & Professor, Department of oral medicine and radiology, The oxford dental college and research center, Bangalore 3M.D.S - Master of Dental surgery, Department of oral medicine and radiology, Senior lecturer, The oxford dental college and research center, Bangalore 4M.D.S – Master of Dental surgery, Department of oral medicine and radiology, Bangalore Received: August 19, 2018; Published: August 24, 2018 *Corresponding author: Karthik D Yadav, 10th Milestone, Bommanahalli, Hosur Road, Bangalore-560 102, India Short Communication combination of all these drugs is more effective in treating HSV The term “herpes” creates panic among the general population. infections than the anesthetic preparations alone. They are also Oral herpes simplex virus is most commonly seen affecting the oral soft tissue region the perioral area [1,2]. They have been categorized treating HSV. Further, ice can be used and lip materials containing into HSV -1 and HSV -2, wherein HSV-1 affects the orofacial region, used with systemic antiviral agents for increased efficacy while cocoa, lanolin and petroleum products have been recommended to most commonly above the waist region and HSV-2 affects the treat recurrent herpes [6]. genital region below the waist. However, change in sexual practices have been the basis for the variations of the virus, affecting the While the use of topical drugs has few adverse effects and are non-conventional regions of the body [3,4].
    [Show full text]
  • Silibinin Component for the Treatment of Hepatitis Silbininkomponente Zur Behandlung Von Hepatitis Composant De Silibinine Pour Le Traitement De L’Hépatite
    (19) & (11) EP 2 219 642 B1 (12) EUROPEAN PATENT SPECIFICATION (45) Date of publication and mention (51) Int Cl.: of the grant of the patent: A61K 31/357 (2006.01) A61P 1/16 (2006.01) 21.09.2011 Bulletin 2011/38 A61P 31/12 (2006.01) (21) Application number: 08849759.9 (86) International application number: PCT/EP2008/009659 (22) Date of filing: 14.11.2008 (87) International publication number: WO 2009/062737 (22.05.2009 Gazette 2009/21) (54) SILIBININ COMPONENT FOR THE TREATMENT OF HEPATITIS SILBININKOMPONENTE ZUR BEHANDLUNG VON HEPATITIS COMPOSANT DE SILIBININE POUR LE TRAITEMENT DE L’HÉPATITE (84) Designated Contracting States: (56) References cited: AT BE BG CH CY CZ DE DK EE ES FI FR GB GR WO-A-02/067853 GB-A- 2 167 414 HR HU IE IS IT LI LT LU LV MC MT NL NO PL PT RO SE SI SK TR • POLYAK STEPHEN J ET AL: "Inhibition of T- cell inflammatory cytokines, hepatocyte NF-kappa B (30) Priority: 15.11.2007 EP 07022187 signaling, and HCV infection by standardized 15.11.2007 US 988168 P silymarin" GASTROENTEROLOGY, vol. 132, no. 25.03.2008 EP 08005459 5, May 2007 (2007-05), pages 1925-1936, XP002477920 ISSN: 0016-5085 (43) Date of publication of application: • MAYER K E ET AL: "Silymarin treatment of viral 25.08.2010 Bulletin 2010/34 hepatitis: A systematic review" JOURNAL OF VIRAL HEPATITIS 200511 GB, vol. 12, no. 6, (60) Divisional application: November 2005 (2005-11), pages 559-567, 11005445.9 XP002477921 ISSN: 1352-0504 1365-2893 • CHAVEZ M L: "TREATMENT OF HEPATITIS C (73) Proprietor: Madaus GmbH WITH MILK THISTLE?" JOURNAL OF HERBAL 51067 Köln (DE) PHARMACOTHERAPY, HAWORTH HERBAL PRESS, BINGHAMTON, US, vol.
    [Show full text]
  • Glaxosmithkline Plc Annual Report for the Year Ended 31St December 2000
    GlaxoSmithKline 01 GlaxoSmithKline plc Annual Report for the year ended 31st December 2000 Contents Report of the Directors 02 Financial summary 03 Joint statement by the Chairman and the Chief Executive Officer 05 Description of business 29 Corporate governance 37 Remuneration report 47 Operating and financial review and prospects 69 Financial statements 70 Directors’ statements of responsibility 71 Report by the auditors 72 Consolidated statement of profit and loss 72 Consolidated statement of total recognised gains and losses 74 Consolidated statement of cash flow 76 Consolidated balance sheet 76 Reconciliation of movements in equity shareholders’ funds 77 Company balance sheet 78 Notes to the financial statements 136 Group companies 142 Principal financial statements in US$ 144 Financial record 153 Investor information 154 Shareholder return 156 Taxation information for shareholders 157 Shareholder information 158 Share capital 160 Cross reference to Form 20-F 162 Glossary of terms The Annual Report was approved by the Board 163 Index of Directors on 22nd March 2001 and published on 12th April 2001. Contact details 02 GlaxoSmithKline Financial summary 2000 1999 Increase Business performance £m £m CER % £ % Sales 18,079 16,164 9 12 Trading profit 5,026 4,378 12 15 Profit before taxation 5,327 4,708 11 13 Earnings/Net income 3,697 3,222 13 15 Earnings per Ordinary Share 61.0p 52.7p 14 16 Total results Profit before taxation 6,029 4,236 Earnings/Net income 4,154 2,859 Earnings per Ordinary Share 68.5p 46.7p Business performance: results exclude merger items and restructuring costs; 1999 sales and trading profit exclude the Healthcare Services businesses which were disposed of in 1999.
    [Show full text]
  • Medication Guide
    2040755 200/300 mg Emtricitabine and Tenofovir Disoproxil Fumarate Tablets HIGHLIGHTS OF PRESCRIBING INFORMATION Recommended dose in renally impaired HIV-uninfected individuals: Do not use emtricitabine and tenofovir 7 DRUG INTERACTIONS 16 HOW SUPPLIED/STORAGE AND HANDLING Coadministered Dose of Coadministered % Change of Tenofovir Pharmacokinetic These highlights do not include all the information needed to use EMTRICITABINE AND TENOFOVIR DISOPROXIL disoproxil fumarate tablets in HIV-uninfected individuals if CrCl is below 60 mL/min. If a decrease in CrCl is No drug interaction trials have been conducted using emtricitabine and tenofovir disoproxil fumarate tablets. Drug N Parametersb (90% CI) observed in uninfected individuals while using emtricitabine and tenofovir disoproxil fumarate tablets for PrEP, Drug Drug (mg) The blue, capsule shaped, film coated tablets contain 200 mg of emtricitabine and 300 mg of tenofovir disoproxil FUMARATE TABLETS safely and effectively. See full prescribing information for EMTRICITABINE AND TENOFOVIR interaction trials have been conducted with emtricitabine and tenofovir disoproxil fumarate, the components of C AUC C fumarate (which is equivalent to 245 mg of tenofovir disoproxil), are debossed with H on one side and with 124 DISOPROXIL FUMARATE TABLETS. evaluate potential causes and re-assess potential risks and benefits of continued use. (2.4) max min emtricitabine and tenofovir disoproxil fumarate tablet. This section describes clinically relevant drug interactions h 14 on the other side, and are available in unit of use bottles [containing a dessicant (silica gel sachet) and closed with a EMTRICITABINE and TENOFOVIR DISOPROXIL FUMARATE tablets, for oral use -------------------------------------------------DOSAGE FORMS AND STRENGTHS--------------------------------------------- observed with emtricitabine and tenofovir disoproxil fumarate [See Clinical Pharmacology (12.3)].
    [Show full text]
  • Tenofovir, Another Inexpensive, Well-Known and Widely Available Old Drug Repurposed for SARS-COV-2 Infection
    pharmaceuticals Review Tenofovir, Another Inexpensive, Well-Known and Widely Available Old Drug Repurposed for SARS-COV-2 Infection Isabella Zanella 1,2,* , Daniela Zizioli 1, Francesco Castelli 3 and Eugenia Quiros-Roldan 3 1 Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; [email protected] 2 Clinical Chemistry Laboratory, Cytogenetics and Molecular Genetics Section, Diagnostic Department, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy 3 University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; [email protected] (F.C.); [email protected] (E.Q.-R.) * Correspondence: [email protected]; Tel.: +39-030-399-6806 Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is spreading worldwide with different clinical manifestations. Age and comorbidities may explain severity in critical cases and people living with human immunodeficiency virus (HIV) might be at particularly high risk for severe progression. Nonetheless, current data, although sometimes contradictory, do not confirm higher morbidity, risk of more severe COVID-19 or higher mortality in HIV-infected people with complete access to antiretroviral therapy (ART). A possible protective role of ART has been hypothesized to explain these observations. Anti-viral drugs used to treat HIV infection have been repurposed for COVID-19 treatment; this is also based on previous studies on severe acute respiratory syndrome virus (SARS-CoV) and Middle East respiratory syndrome virus (MERS-CoV). Among Citation: Zanella, I.; Zizioli, D.; them, lopinavir/ritonavir, an inhibitor of viral protease, was extensively used early in the pandemic Castelli, F.; Quiros-Roldan, E.
    [Show full text]
  • Safety and Efficacy of Antiviral Therapy for Prevention of Cytomegalovirus Reactivation in Immunocompetent Critically Ill Patien
    1 2 3 PROJECT TITLE 4 Anti-viral Prophylaxis for Prevention of Cytomegalovirus (CMV) Reactivation in Immunocompetent 5 Patients in Critical Care 6 7 STUDY ACRONYM 8 Cytomegalovirus Control in Critical Care - CCCC 9 10 APPLICANTS 11 Dr Nicholas Cowley 12 Specialty Registrar Anaesthesia and Intensive Care Medicine, Intensive Care Research Fellow 13 Queen Elizabeth Hospital Birmingham 14 15 Professor Paul Moss 16 Professor of Haematology 17 Queen Elizabeth Hospital Birmingham 18 19 Professor Julian Bion 20 Professor of Intensive Care Medicine 21 Queen Elizabeth Hospital Birmingham 22 23 Trial Virologist Trial Statistician 24 Dr H Osman Dr P G Nightingale 25 Queen Elizabeth Hospital Birmingham University of Birmingham CCCC CMV Protocol V1.7, 18th September 2013 1 Downloaded From: https://jamanetwork.com/ on 09/23/2021 26 CONTENTS 27 Substantial Amendment Sept 18th 2013 4 28 1 SUMMARY OF TRIAL DESIGN .......................................................................................................... 5 29 2 QEHB ICU Duration of Patient Stay ................................................................................................. 6 30 3 SCHEMA - QEHB PATIENT NUMBERS AVAILABLE FOR RECRUITMENT ........................................... 6 31 4 INTRODUCTION ............................................................................................................................... 7 32 4.1 CMV latent infection is widespread ........................................................................................ 7 33 4.2 CMV Reactivation
    [Show full text]