Zidovudine-induced reversible pure red cell aplasia

Balakrishnan, Anuja; Valsalan, Rohith; Sheshadri, Shubha; Pandit, Vinay; Medep, Vikas; Agrawal, Ravindra

doi:10.4103/0253-7613.66845

Cited by 16 publications

(11 citation statements)

References 8 publications

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“…In spite of having so much of beneficial record of AZT [ 22 ], the previous (pharmacokinetics) PK studies showed that, AZT is responsible for the bone marrow toxicity [ 23 ] which leads to bone marrow suppression [ 24 ] and finally results to various alteration related to hematopoiesis [ 25 – 27 ]. Further AZT has been proven as a genotoxic compound [ 28 , 29 ] which cause the induction of micronuclei in the mouse bone marrow cells [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

Improved Safety, Bioavailability and Pharmacokinetics of Zidovudine through Lactoferrin Nanoparticles during Oral Administration in Rats

et al. 2015

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Zidovudine (AZT) is one of the most referred antiretroviral drug. In spite of its higher bioavailability (50–75%) the most important reason of its cessation are bone marrow suppression, anemia, neutropenia and various organs related toxicities. This study aims at the improvement of oral delivery of AZT through its encapsulation in lactoferrin nanoparticles (AZT-lactonano). The nanoparticles (NPs) are of 50–60 nm in size and exhibit 67% encapsulation of the AZT. They are stable in simulated gastric and intestinal fluids. Anti-HIV-1 activity of AZT remains unaltered in nanoformulation in acute infection. The bioavailability and tissue distribution of AZT is higher in blood followed by liver and kidney. AZT-lactonano causes the improvement of pharmacokinetic profile as compared to soluble AZT; a more than 4 fold increase in AUC and AUMC in male and female rats. The serum Cmax for AZT-lactonano was increased by 30%. Similarly there was nearly 2-fold increase in Tmax and t1/2. Our in vitro study confirms that, the endosomal pH is ideal for drug release from NPs and shows constant release from up to 96h. Bone marrow micronucleus assay show that nanoformulation exhibits approximately 2fold lower toxicity than soluble form. Histopathological and biochemical analysis further confirms that less or no significant organ toxicities when nanoparticles were used. AZT-lactonano has shown its higher efficacy, low organs related toxicities, improved pharmacokinetics parameter while keeping the antiviral activity intact. Thus, the nanoformulation are safe for the target specific drug delivery.

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Section: Introductionmentioning

confidence: 99%

Improved Safety, Bioavailability and Pharmacokinetics of Zidovudine through Lactoferrin Nanoparticles during Oral Administration in Rats

et al. 2015

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“…ZDV is associated with hematologic toxicity including neutropenia and anemia, particularly in patients with advanced HIV-1 disease. In addition, pure red cell aplasia occurs with ZDV after 6 weeks to 4 years of therapy 24–26 .…”

Section: Discussionmentioning

confidence: 99%

Nevirapine Inhibits the Anti-HIV Activity of CD8+ Cells

Liu

Wang²,

Huang³

et al. 2013

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Antiretroviral therapy (ART) significantly reduced the CD8+ cell non-cytotoxic anti-HIV response (CNAR) in twelve HIV-1-infected subjects (p < 0.0001). In separate experiments, CD8+ cells from long term survivors (LTS) were co-cultured with HIV-infected CD4+ cells using varying concentrations of anti-HIV drugs. The antiviral function of CD8+ cells from four of fourteen LTS was reduced with exposure to 10µM nevirapine (p < 0.05). The antiviral activity of CD8+ cells from two LTS was inhibited by 5µM zidovudine. These studies indicate that nevirapine and probably zidovudine can inhibit the anti-HIV activity of CD8+ cells and thus could influence the effectiveness of ART.

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“…59 AZT is associated with macrocytosis, 62 but rarely associated with severe anaemia as a result of a pure red cell aplasia. 64 If there is adequate time remaining in the pregnancy, patients who are treatment-naïve, do not qualify for full ART, and have an Hb <10g/dl, should receive a full course of haematinics and their response observed. Their response should be re-assessed after 2 weeks and, if there is a response, AZT be commenced.…”

Section: Transfusion Medicine Best Practicementioning

confidence: 99%

A review of the use of blood and blood products in HIV-infected patients

Berg

Hasselt²,

Bloch³

et al. 2012

Southern African Journal of HIV Medicine

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Despite numerous publications on the appropriate use of blood and blood products, few specifically consider the role of transfusion in the management of HIV. This review is a synthesis of conditions encountered in the management of HIV-infected patients where the transfusion of blood or blood products may be indicated. A consistent message emerging from the review is that the principles of transfusion medicine do not differ between HIV-negative and -positive patients. The aim of the review is to provide clinicians with a practical and succinct overview of the haematological abnormalities and clinical circumstances most commonly encountered in the HIV setting, while focusing on the rational and appropriate use of blood and blood products for HIV patients. Important ethical considerations in dealing with both the collection and transfusion blood and blood products in the HIV era have also been addressed.

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Zidovudine-induced reversible pure red cell aplasia

Cited by 16 publications

References 8 publications

Improved Safety, Bioavailability and Pharmacokinetics of Zidovudine through Lactoferrin Nanoparticles during Oral Administration in Rats

Improved Safety, Bioavailability and Pharmacokinetics of Zidovudine through Lactoferrin Nanoparticles during Oral Administration in Rats

Nevirapine Inhibits the Anti-HIV Activity of CD8+ Cells

A review of the use of blood and blood products in HIV-infected patients

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