Fármacocinética del genérico zidovudina en pacientes cubanos infectados por el virus de la inmunodeficiencia humana

Agradecemos al personal médico y de enfermería del Hospital del Instituto “Pedro Kourí” que atendió a los pacientes incluidos en el estudio. Así como al técnico Ramón Caro que ayudó en la preparación de soluciones y muestras.Objetivo: El objetivo del presente trabajo es caracterizar los parámetros farmacocinéticos de la zidovudina (AZT) en pacientes cubanos seropositivos al virus de la inmunodeficiencia humana (VIH). Materiales y métodos: Para ello se realizó un estudio de dosis única (300mg) a 13 pacientes “naives” seropositivos al VIH-1 donde se midieron, según la cinética establecida, las concentraciones de AZT en plasma y orina. Estas concentraciones se determinaron por cromatografía líquida de alta resolución en fase reversa (RP-HPLC) con detección UV (λ=267nm). Resultados: Los parámetros farmacocinéticos fueron calculados usando técnicas estándares no compartimentales. Entre las variables determinadas están: Concentración máxima (Cmax= 3,35±1,41 μg/mL), Recobrado urinario (RU= 25,36±9,25%), Aclaramiento renal (ClR= 17,56±7,78L/h), Aclaramiento plasmático (CLp= 47,09±29,45 L/h), Tiempo de vida media de eliminación (t½= 1,19±0,30h) y Biodisponibilidad relativa (F= 63,12±16,59%). Conclusiones: Los valores de los parámetros calculados posibilitan la caracterización del perfil farmacocinético del genérico cubano AZT. Esto es útil para posteriores correcciones de los regímenes de dosificación según las especificidades de cada paciente.Aims: The purpose of this study was to characterize pharmacokinetic parameters of zidovudine generic (AZT) in human inmunodeficiency virus (HIV) infected cuban patients. Materials and methods: A single-dose study (300mg AZT) was made in 13 ¨naive¨ patientes for determination of the AZT concentrations in plasma and urine, fallowed an established kinetic. These concentration values were measured by reversed-phase liquid chromatography (RP-HPLC) with UV detection (λ=267nm). Results: Pharmacokinetic parameters for zidovudine were estimated from data of concentration in plasma and urine versus time by using noncompartmental methods. The most important parameters obtained were: maximum concentration (Cmax= 3,35±1,41 μg/mL), urinary recovery (UR= 25,36±9,25 %), renal clearance (ClR= 17,56±7,78L/h), plasmatic clearance (CLp= 47,09±29,45 L/h), terminal elimination half-life (t½= 1,19±0,30h), and apparent bioavailability (F= 63,12±16,59%). Conclusions: The values of pharmacokinetic parameters made possible to the establishment of the pharmacokinetic profile for the Cuban generic zidovudine. This is very important for future dose adjustment of patients

Pharmacokinetic of generic formulations of zidovudine in human immunodeficiency virus infected cuban patients.

Objetivo: El objetivo del presente trabajo es caracterizar los parámetros farmacocinéticos de la zidovudina (AZT) en pacientes cubanos seropositivos al virus de la inmunodeficiencia humana (VIH).Materiales y métodos: Para ello se realizó un estudio de dosis única (300mg) a 13 pacientes “naives” seropositivos al VIH-1 donde se midieron, según la cinética establecida, las concentraciones de AZT en plasma y orina. Estas concentraciones se determinaron por cromatografía líquida de alta resolución en fase reversa (RP-HPLC) con detección UV (λ=267nm).Resultados: Los parámetros farmacocinéticos fueron calculados usando técnicas estándares no compartimentales. Entre las variables determinadas están: Concentración máxima (Cmax= 3,35±1,41 μg/mL), Recobrado urinario (RU= 25,36±9,25%), Aclaramiento renal (ClR= 17,56±7,78L/h), Aclaramiento plasmático (CLp= 47,09±29,45 L/h), Tiempo de vida media de eliminación (t½= 1,19±0,30h) y Biodisponibilidad relativa (F= 63,12±16,59%).Conclusiones: Los valores de los parámetros calculados posibilitan la caracterización del perfil farmacocinético del genérico cubano AZT. Esto es útil para posteriores correcciones de los regímenes de dosificación según las especificidades de cada paciente.Aims: The purpose of this study was to characterize pharmacokinetic parameters of zidovudine generic (AZT) in human inmunodeficiency virus (HIV) infected cuban patients.Materials and methods: A single-dose study (300mg AZT) was made in 13 ¨naive¨ patientes for determination of the AZT concentrations in plasma and urine, fallowed an established kinetic. These concentration values were measured by reversed-phase liquid chromatography (RP-HPLC) with UV detection (λ=267nm).Results: Pharmacokinetic parameters for zidovudine were estimated from data of concentration in plasma and urine versus time by using noncompartmental methods. The most important parameters obtained were: maximum concentration (Cmax= 3,35±1,41 μg/mL), urinary recovery (UR= 25,36±9,25 %), renal clearance (ClR= 17,56±7,78L/h), plasmatic clearance (CLp= 47,09±29,45 L/h), terminal elimination half-life (t½= 1,19±0,30h), and apparent bioavailability (F= 63,12±16,59%).Conclusions: The values of pharmacokinetic parameters made possible to the establishment of the pharmacokinetic profile for the Cuban generic zidovudine. This is very important for future dose adjustment of patients

Effect of increase, of dietary micronutrient intake on oxidative stress indicators in HIV/AIDS patients

Several human studies in immunodeficiency virus (HIV) patients have identified macronutrient deficiencies as affecting progression to acquired immunodeficiency syndrome (AIDS) and death. Although the mechanisms are not known, micronutrient deficiencies may exacerbate the oxidative stress induced by HIV. In addition, infection and its evolution likely lead to an increased requirement for nutritional micronutrients, especially antioxidants. To evaluate this, 40 relatively healthy, institutionalized HIV-infected individuales were recruited for assessment before or three month after fresh fruit and vegetable supply were increased due to seasonal supply. Seven-day dietary records were recorded at the beginning (December) and end of the three-month study period (March). Oxidative stress indices and CD4+, CD38+/CD8+, and CD95+ T-lymphocyte subsets were also measured at these times. No significant differences were found in calorie or protein intake across the study period, but vitamin A, C, and E intakes all increased. A number of redox indicators were modified (increase total antioxidant status, glutathione peroxidase, and glutathione, and decrease: superoxide dismutase) during the study period. However, no change in malondialdehyde, hydroperoxides, or DNA damage was noted but a significant reduction in CD38+/CD8+ relative count was seen. Within the context and limitations of this study, the increase of dietary fruits and vegetable intake for three months had some beneficial effects on nutrition, systemic redox balance, and immune parameters in HIV-infected persons

Contribution to characterization of oxidative stress in HIV/AIDS patients

Infection by human immunodeficiency virus (HIV) causes persistent chronic inflammation. Viral Tat protein plays a role in the intracellular increase of reactive oxygen species (ROS) thus increasing apoptotic index, mostly the one mediated by FAS/CD95, and depleting CD4+ T lymphocytes. The aim of this study was to investigate whether there is a relationship between an extensive array of redox status indices (glutathione (GSH), malondialdehyde (MDA), peroxidation potential, total antioxidant status, glutathione peroxidase (GPx), superoxide dismutase (SOD), total hydroperoxide (TH), DNA fragmentation) and relative CD4, CD95, CD38/CD8 T lymphocyte counts in HIV/AIDS patients compared to healthy subjects. Blood samples from 85 HIV/AIDS patients and 40 healthy subjects were tested by spectrophotometric techniques in order to measure oxidative stress indices, and by flow cytometry to quantify T cell subsets. Patients were divided in two groups according to CDC 1993 guidelines. CD95 and CD38 increase paralleled the severity of HIV infection. Both a reduction of GSH levels and an increase in MDA and TH levels were detected in the plasma of HIV+ patients. These patients also showed an increase of DNA fragmentation in lymphocytes as well as a significant (P<0.05) reduction of GPx and an increase in SOD activity in erythrocytes. Relatively to the control group, HIV-infected patients had significantly differences in global indices of total antioxidant status. These results corroborate that substantial oxidative stress occurs during HIV infection. To our knowledge this study is the first relating oxidative stress indices with both CD38/CD8 and CD95 lymphocytes subsets

Therapeutic drug monitoring by LC-MS-MS with special focus on anti-infective drugs

Liquid chromatography coupled to mass spectrometry nowadays plays an important role in the field of therapeutic drug monitoring (TDM), especially of new compounds for which no immunoassays are available. This paper reviews LC-MS(-MS) methods published recently for anti-infective drugs: antiretroviral drugs, other antiviral drugs, antibacterial drugs, antihelmintic drugs, antimalarial drugs, and other antiprotozoal drugs. An overview of the different methods is given, with special focus on selection of the internal standard and validation procedures