The Critical Need for Alternative Antiretroviral Formulations, and Obstacles to Their Development
Open accessAbstract
A 53-year-old black man with advanced human immunodeficiency virus (HIV) disease and hepatitis B coinfection was admitted to the hospital with severe ondynophagia. An upper gastrointestinal endoscopy revealed fungal esophagitis with a bronchial fistula. The patient could take nothing by mouth, so a stent and gastrostomy tube were placed and intravenous antifungal and antibiotic therapy was initiated. However, provision of antiretroviral therapy was more challenging. The patient had failed multiple antiretroviral regimens with development of resistance-associated mutations, but a regimen including tenofovir, etravirine, and raltegravir had potential activity for treating both HIV and hepatitis B infections. The patient’s CD4 count was 73 cells/mm3. Improvement in immunosuppression was key to his lasting recovery, but none of the agents selected were available in a parenteral formulation or a liquid preparation. Data on the safety and efficacy of dissolving or crushing these tablets was limited or lacking, and the best course of treatment for this individual was unclear.
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Long-acting injectable nanoparticles allow drugs to be administered to dysphagic patients.
“They also allow drugs to be administered to dysphagic patients, for example individuals infected with HIV and suffering from opportunistic oesophageal infections 88 .”
From Nanotechnology approaches for global infectious diseases (2021) · cites this paper as [88]
Both rilpivirine and cabotegravir nanosuspensions were safe and devoid of major adverse effects.
“Both nanosuspensions were safe and devoid of major adverse effects 88 .”
From Nanotechnology approaches for global infectious diseases (2021) · cites this paper as [88]
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Nanotechnology approaches for global infectious diseases
Kirtane, A. R., Verma, M., Karandikar, P., Furin, J., Langer, R., & Traverso, G. (2021) · Nature Nanotechnology · doi:10.1038/s41565-021-00866-8 · Cited by 520 · see citing works
- Authors
- Swindells, S., Flexner, C., Fletcher, C. V., & Jacobson, J. M.
- Affiliations
- University of Nebraska Medical Center (US)
- Johns Hopkins University (US)
- Drexel University (US)
- Venue
- The Journal of Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-09-01
- Volume
- 204
- Issue
- 5
- Pages
- 669-674
- ISSN
- 0022-1899 (ISSN-L)
- 1537-6613
- PMC
- PMC3156101
- OpenAlex
- W2157645841
- Cited by
- 42
- References
- 29
- Citations by year
- 2025: 4 · 2023: 1 · 2022: 1 · 2021: 4 · 2020: 2 · 2019: 1 · 2018: 3 · 2017: 2 · 2016: 1 · 2015: 7 · 2014: 8 · 2013: 5 · 2012: 2
- FWCI
- 3.47
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Infectious Diseases (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Drug Abuse (P01DA028555)
- National Institute of Allergy and Infectious Diseases (UOI AI6863, UOI AI68636, U01AI068636, AI069465, U01AI-69450, U01-AI68636, U01AI069450, U01AI068634, P01AI074340)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
- Keywords
- antiretroviral therapy, HIV, hepatitis B coinfection, drug resistance, tenofovir, etravirine, raltegravir, parenteral formulations, tablet crushing, immunosuppression, esophagitis, bronchial fistula
- MeSH terms
- Animals, Dosage Forms, Humans, Infusions, Parenteral, Male, Middle Aged, HIV Infections, Anti-Retroviral Agents
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