Novel Approaches for Delivery of Anti-HIV Drugs

A special issue of Pharmaceutics (ISSN 1999-4923).

Deadline for manuscript submissions: closed (20 February 2019) | Viewed by 48829

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Institute for Research and Innovation in Health, University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
Interests: drug delivery; infectious diseases; nanomedicine; nanotechnology; pharmaceutics; women’s health
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Dear Colleagues,

HIV/AIDS continues to be one of the most challenging individual and public health concerns of our days, affecting roughly 37 million individuals worldwide and killing nearly two million people each year according to the UNAIDS (The Joint United Nations Programme on HIV/AIDS). Investments in the field have been huge but a cure to the infection remains elusive. Nonetheless, tremendous advances have been made over the last 35 years since the HIV-1 was identified, namely in prevention, diagnostics and treatment. The development of antiretroviral drugs and the introduction of highly active antiretroviral therapy (HAART) in the mid-1990s—currently referred to as combination antiretroviral therapy (cART)—led to a dramatic shift of AIDS from a fatal disease into a chronic and often stable medical condition. In fact, cART contributed decisively to a steady decrease in the number of HIV-related deaths since the first years of the new millennium. Antiretroviral drugs have also been found useful in the prevention field, particularly in post-exposure prophylaxis (PEP) or mother-to-child transmission. Treatment as prevention and pre-exposure prophylaxis (PrEP) have further contributed to the reduction of sexually-transmitted HIV infections. Long-lasting injectable products and antiretroviral-based microbicides that are currently in late stages of clinical development or regulatory approval may soon provide new options for prevention. Gene therapy and the use of broadly neutralizing antibodies is also attracting a great deal of interest as possible approaches to HIV/AIDS management.

Still, many challenges remain in anti-HIV drug therapy/prophylaxis and these include, among others: (i) the onset of severe adverse effects leading to discontinuation or interruption of therapy/prophylaxis; (ii) sub-optimal biodistribution and pharmacokinetics, particularly at reservoir sites or mucosae involved in sexual transmission; (iii) the occurrence of viral resistance; (iv) troublesome regimens and/or drug delivery routes that lead to poor adherence by patients/users; (v) low stability and reduced shelf-life of active molecules, which may be particularly challenging in tropical climates and low-resource regions lacking adequate refrigerated distribution channels and storage; (vi) lack of adequate dosage forms for particular populations (e.g. children, women); (vii) costly drug products that are often inaccessible to populations in need of therapy/prophylaxis; and (viii) social and legal constraints resulting in poor access to and discontinuation of anti-HIV therapy/prophylaxis.

This Special Issue of Pharmaceutics intends to focus on new strategies and approaches to the formulation and delivery of anti-HIV drugs (including genetic material and other biopharmaceuticals), which could help solving many of the above identified issues. We welcome articles on all aspects of anti-HIV drug delivery intended at advancing therapy or prophylaxis of HIV/AIDS.

Dr. José das Neves
Guest Editor

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Keywords

  • Acquired Immunodeficiency Syndrome (AIDS)
  • Anti-HIV Agents
  • Antiretroviral Drug Delivery
  • Broadly Neutralizing Antibodies
  • Combination Antiretroviral Therapy (cART)
  • Combination Products
  • Gene Therapy
  • Human Immunodeficiency Virus (HIV)
  • Long Acting Injectables
  • Microbicide Vaginal Rings
  • Mother-To-Child Transmission
  • Multipurpose Prevention Technologies
  • Nanomedicines
  • NeuroAIDS
  • Pharmacokinetics
  • Post-Exposure Prophylaxis (PEP)
  • Pre-Exposure Prophylaxis (PrEP)
  • Rectal Microbicides
  • Reservoir Sites
  • Vaginal Microbicides

Published Papers (10 papers)

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Editorial

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4 pages, 194 KiB  
Editorial
Novel Approaches for the Delivery of Anti-HIV Drugs—What Is New?
by José das Neves
Pharmaceutics 2019, 11(11), 554; https://doi.org/10.3390/pharmaceutics11110554 - 28 Oct 2019
Cited by 4 | Viewed by 2294
Abstract
HIV/AIDS continues to be one of the most challenging individual and public health concerns of our days [...] Full article
(This article belongs to the Special Issue Novel Approaches for Delivery of Anti-HIV Drugs)

Research

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16 pages, 2833 KiB  
Article
Characterization of a Reservoir-Style Implant for Sustained Release of Tenofovir Alafenamide (TAF) for HIV Pre-Exposure Prophylaxis (PrEP)
by Leah M. Johnson, Sai Archana Krovi, Linying Li, Natalie Girouard, Zach R. Demkovich, Daniel Myers, Ben Creelman and Ariane van der Straten
Pharmaceutics 2019, 11(7), 315; https://doi.org/10.3390/pharmaceutics11070315 - 04 Jul 2019
Cited by 63 | Viewed by 5590
Abstract
Long-acting (LA) HIV pre-exposure prophylaxis (PrEP) offers the potential to improve adherence by lowering the burden of daily or on-demand regimens of antiretroviral (ARV) drugs. This paper details the fabrication and in vitro performance of a subcutaneous and trocar-compatible implant for the LA [...] Read more.
Long-acting (LA) HIV pre-exposure prophylaxis (PrEP) offers the potential to improve adherence by lowering the burden of daily or on-demand regimens of antiretroviral (ARV) drugs. This paper details the fabrication and in vitro performance of a subcutaneous and trocar-compatible implant for the LA delivery of tenofovir alafenamide (TAF). The reservoir-style implant comprises an extruded tube of a biodegradable polymer, poly(ε-caprolactone) (PCL), filled with a formulation of TAF and castor oil excipient. Parameters that affect the daily release rates of TAF are described, including the surface area of the implant, the thickness of the PCL tube walls (between 45 and 200 µm), and the properties of the PCL (e.g., crystallinity). In vitro studies show a linear relationship between daily release rates and surface area, demonstrating a membrane-controlled release mechanism from extruded PCL tubes. Release rates of TAF from the implant are inversely proportional to the wall thickness, with release rates between approximately 0.91 and 0.15 mg/day for 45 and 200 µm, respectively. The sustained release of TAF at 0.28 ± 0.06 mg/day over the course of 180 days in vitro was achieved. Progress in the development of this implant platform addresses the need for new biomedical approaches to the LA delivery of ARV drugs. Full article
(This article belongs to the Special Issue Novel Approaches for Delivery of Anti-HIV Drugs)
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21 pages, 4037 KiB  
Article
Design of Poly(lactic-co-glycolic Acid) (PLGA) Nanoparticles for Vaginal Co-Delivery of Griffithsin and Dapivirine and Their Synergistic Effect for HIV Prophylaxis
by Haitao Yang, Jing Li, Sravan Kumar Patel, Kenneth E. Palmer, Brid Devlin and Lisa C. Rohan
Pharmaceutics 2019, 11(4), 184; https://doi.org/10.3390/pharmaceutics11040184 - 16 Apr 2019
Cited by 79 | Viewed by 6384
Abstract
Long-acting topical products for pre-exposure prophylaxis (PrEP) that combine antiretrovirals (ARVs) inhibiting initial stages of infection are highly promising for prevention of HIV sexual transmission. We fabricated core-shell poly(lactide-co-glycolide) (PLGA) nanoparticles, loaded with two potent ARVs, griffithsin (GRFT) and dapivirine (DPV), [...] Read more.
Long-acting topical products for pre-exposure prophylaxis (PrEP) that combine antiretrovirals (ARVs) inhibiting initial stages of infection are highly promising for prevention of HIV sexual transmission. We fabricated core-shell poly(lactide-co-glycolide) (PLGA) nanoparticles, loaded with two potent ARVs, griffithsin (GRFT) and dapivirine (DPV), having different physicochemical properties and specifically targeting the fusion and reverse transcription steps of HIV replication, as a potential long-acting microbicide product. The nanoparticles were evaluated for particle size and zeta potential, drug release, cytotoxicity, cellular uptake and in vitro bioactivity. PLGA nanoparticles, with diameter around 180–200 nm, successfully encapsulated GRFT (45% of initially added) and DPV (70%). Both drugs showed a biphasic release with initial burst phase followed by a sustained release phase. GRFT and DPV nanoparticles were non-toxic and maintained bioactivity (IC50 values of 0.5 nM and 4.7 nM, respectively) in a cell-based assay. The combination of drugs in both unformulated and encapsulated in nanoparticles showed strong synergistic drug activity at 1:1 ratio of IC50 values. This is the first study to co-deliver a protein (GRFT) and a hydrophobic small molecule (DPV) in PLGA nanoparticles as microbicides. Our findings demonstrate that the combination of GRFT and DPV in nanoparticles is highly potent and possess properties critical to the design of a sustained release microbicide. Full article
(This article belongs to the Special Issue Novel Approaches for Delivery of Anti-HIV Drugs)
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29 pages, 3310 KiB  
Article
Development of a Transdermal Delivery System for Tenofovir Alafenamide, a Prodrug of Tenofovir with Potent Antiviral Activity Against HIV and HBV
by Ashana Puri, Sonalika A. Bhattaccharjee, Wei Zhang, Meredith Clark, Onkar N. Singh, Gustavo F. Doncel and Ajay K. Banga
Pharmaceutics 2019, 11(4), 173; https://doi.org/10.3390/pharmaceutics11040173 - 09 Apr 2019
Cited by 40 | Viewed by 6492
Abstract
Tenofovir alafenamide (TAF) is an effective nucleotide reverse transcriptase inhibitor that is used in the treatment of HIV-1 and HBV. Currently, it is being investigated for HIV prophylaxis. Oral TAF regimens require daily intake, which hampers adherence and increases the possibility of viral [...] Read more.
Tenofovir alafenamide (TAF) is an effective nucleotide reverse transcriptase inhibitor that is used in the treatment of HIV-1 and HBV. Currently, it is being investigated for HIV prophylaxis. Oral TAF regimens require daily intake, which hampers adherence and increases the possibility of viral resistance. Long-acting formulations would significantly reduce this problem. Therefore, the aim of this study was to develop a transdermal patch containing TAF and investigate its performance in vitro through human epidermis. Two types of TAF patches were manufactured. Transparent patches were prepared using acrylate adhesive (DURO-TAK 87-2516), and suspension patches were prepared using silicone (BIO-PSA 7-4301) and polyisobutylene (DURO-TAK 87-6908) adhesives. In vitro permeation studies were performed while using vertical Franz diffusion cells for seven days. An optimized silicone-based patch was characterized for its adhesive properties and tested for skin irritation. The acrylate-based patches, comprising 2% w/w TAF and a combination of chemical enhancers, showed a maximum flux of 0.60 ± 0.09 µg/cm2/h. However, the silicone-based patch comprising of 15% w/w TAF showed the highest permeation (7.24 ± 0.47 μg/cm2/h). This study demonstrates the feasibility of developing silicone-based transdermal patches that can deliver a therapeutically relevant dose of TAF for the control of HIV and HBV infections. Full article
(This article belongs to the Special Issue Novel Approaches for Delivery of Anti-HIV Drugs)
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20 pages, 4793 KiB  
Article
Tenofovir Hot-Melt Granulation using Gelucire® to Develop Sustained-Release Vaginal Systems for Weekly Protection against Sexual Transmission of HIV
by Fernando Notario-Pérez, Raúl Cazorla-Luna, Araceli Martín-Illana, Roberto Ruiz-Caro, Juan Peña and María-Dolores Veiga
Pharmaceutics 2019, 11(3), 137; https://doi.org/10.3390/pharmaceutics11030137 - 20 Mar 2019
Cited by 17 | Viewed by 3808
Abstract
Hot-melt granulation is a technique used to obtain granules by dispersing a drug in polymers at a high temperature. Tenofovir, an antiretroviral drug with proven activity as a vaginal microbicide, was dispersed in melted Gelucire® (or a mixture of different Gelucire® [...] Read more.
Hot-melt granulation is a technique used to obtain granules by dispersing a drug in polymers at a high temperature. Tenofovir, an antiretroviral drug with proven activity as a vaginal microbicide, was dispersed in melted Gelucire® (or a mixture of different Gelucire®) to obtain drug-loaded granules. Studies performed on the granules proved that the drug is not altered in the hot-melt granulation process. The granules obtained were included in a matrix formed by the hydrophilic polymers hydroxypropylmethylcellulose and chitosan to obtain vaginal tablets that combine different mechanisms of controlled release: The Gelucire® needs to soften to allow the release of the Tenofovir, and the hydrophilic polymers must form a gel so the drug can diffuse through it. The studies performed with the tablets were swelling behavior, Tenofovir release, and ex vivo mucoadhesion. The tablets containing granules obtained with Tenofovir and Gelucire® 43/01 in a ratio of 1:2 in a matrix formed by hydroxypropylmethylcellulose and chitosan in a ratio of 1.9:1 were selected as the optimal formulation, since they release Tenofovir in a sustained manner over 216h and remain attached to the vaginal mucosa throughout. A weekly administration of these tablets would therefore offer women protection against the sexual transmission of HIV. Full article
(This article belongs to the Special Issue Novel Approaches for Delivery of Anti-HIV Drugs)
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Review

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13 pages, 2194 KiB  
Review
Eradication of Human Immunodeficiency Virus Type-1 (HIV-1)-Infected Cells
by Nejat Düzgüneş and Krystyna Konopka
Pharmaceutics 2019, 11(6), 255; https://doi.org/10.3390/pharmaceutics11060255 - 01 Jun 2019
Cited by 6 | Viewed by 3489
Abstract
Predictions made soon after the introduction of human immunodeficiency virus type-1 (HIV-1) protease inhibitors about potentially eradicating the cellular reservoirs of HIV-1 in infected individuals were too optimistic. The ability of the HIV-1 genome to remain in the chromosomes of resting CD4+ T [...] Read more.
Predictions made soon after the introduction of human immunodeficiency virus type-1 (HIV-1) protease inhibitors about potentially eradicating the cellular reservoirs of HIV-1 in infected individuals were too optimistic. The ability of the HIV-1 genome to remain in the chromosomes of resting CD4+ T cells and macrophages without being expressed (HIV-1 latency) has prompted studies to activate the cells in the hopes that the immune system can recognize and clear these cells. The absence of natural clearance of latently infected cells has led to the recognition that additional interventions are necessary. Here, we review the potential of utilizing suicide gene therapy to kill infected cells, excising the chromosome-integrated HIV-1 DNA, and targeting cytotoxic liposomes to latency-reversed HIV-1-infected cells. Full article
(This article belongs to the Special Issue Novel Approaches for Delivery of Anti-HIV Drugs)
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26 pages, 1333 KiB  
Review
Reverse Transcriptase Inhibitors Nanosystems Designed for Drug Stability and Controlled Delivery
by Fedora Grande, Giuseppina Ioele, Maria Antonietta Occhiuzzi, Michele De Luca, Elisabetta Mazzotta, Gaetano Ragno, Antonio Garofalo and Rita Muzzalupo
Pharmaceutics 2019, 11(5), 197; https://doi.org/10.3390/pharmaceutics11050197 - 27 Apr 2019
Cited by 17 | Viewed by 4848
Abstract
An in-depth analysis of nanotechnology applications for the improvement of solubility, distribution, bioavailability and stability of reverse transcriptase inhibitors is reported. Current clinically used nucleoside and non-nucleoside agents, included in combination therapies, were examined in the present survey, as drugs belonging to these [...] Read more.
An in-depth analysis of nanotechnology applications for the improvement of solubility, distribution, bioavailability and stability of reverse transcriptase inhibitors is reported. Current clinically used nucleoside and non-nucleoside agents, included in combination therapies, were examined in the present survey, as drugs belonging to these classes are the major component of highly active antiretroviral treatments. The inclusion of such agents into supramolecular vesicular systems, such as liposomes, niosomes and lipid solid NPs, overcomes several drawbacks related to the action of these drugs, including drug instability and unfavorable pharmacokinetics. Overall results reported in the literature show that the performances of these drugs could be significantly improved by inclusion into nanosystems. Full article
(This article belongs to the Special Issue Novel Approaches for Delivery of Anti-HIV Drugs)
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31 pages, 2571 KiB  
Review
Relating Advanced Electrospun Fiber Architectures to the Temporal Release of Active Agents to Meet the Needs of Next-Generation Intravaginal Delivery Applications
by Kevin M. Tyo, Farnaz Minooei, Keegan C. Curry, Sarah M. NeCamp, Danielle L. Graves, Joel R. Fried and Jill M. Steinbach-Rankins
Pharmaceutics 2019, 11(4), 160; https://doi.org/10.3390/pharmaceutics11040160 - 03 Apr 2019
Cited by 8 | Viewed by 3094
Abstract
Electrospun fibers have emerged as a relatively new delivery platform to improve active agent retention and delivery for intravaginal applications. While uniaxial fibers have been explored in a variety of applications including intravaginal delivery, the consideration of more advanced fiber architectures may offer [...] Read more.
Electrospun fibers have emerged as a relatively new delivery platform to improve active agent retention and delivery for intravaginal applications. While uniaxial fibers have been explored in a variety of applications including intravaginal delivery, the consideration of more advanced fiber architectures may offer new options to improve delivery to the female reproductive tract. In this review, we summarize the advancements of electrospun coaxial, multilayered, and nanoparticle-fiber architectures utilized in other applications and discuss how different material combinations within these architectures provide varied durations of release, here categorized as either transient (within 24 h), short-term (24 h to one week), or sustained (beyond one week). We seek to systematically relate material type and fiber architecture to active agent release kinetics. Last, we explore how lessons derived from these architectures may be applied to address the needs of future intravaginal delivery platforms for a given prophylactic or therapeutic application. The overall goal of this review is to provide a summary of different fiber architectures that have been useful for active agent delivery and to provide guidelines for the development of new formulations that exhibit release kinetics relevant to the time frames and the diversity of active agents needed in next-generation multipurpose applications. Full article
(This article belongs to the Special Issue Novel Approaches for Delivery of Anti-HIV Drugs)
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20 pages, 1940 KiB  
Review
Pharmaceutical Vehicles for Vaginal and Rectal Administration of Anti-HIV Microbicide Nanosystems
by Letícia Mesquita, Joana Galante, Rute Nunes, Bruno Sarmento and José das Neves
Pharmaceutics 2019, 11(3), 145; https://doi.org/10.3390/pharmaceutics11030145 - 26 Mar 2019
Cited by 25 | Viewed by 6708
Abstract
Prevention strategies play a key role in the fight against HIV/AIDS. Vaginal and rectal microbicides hold great promise in tackling sexual transmission of HIV-1, but effective and safe products are yet to be approved and made available to those in need. While most [...] Read more.
Prevention strategies play a key role in the fight against HIV/AIDS. Vaginal and rectal microbicides hold great promise in tackling sexual transmission of HIV-1, but effective and safe products are yet to be approved and made available to those in need. While most efforts have been placed in finding and testing suitable active drug candidates to be used in microbicide development, the last decade also saw considerable advances in the design of adequate carrier systems and formulations that could lead to products presenting enhanced performance in protecting from infection. One strategy demonstrating great potential encompasses the use of nanosystems, either with intrinsic antiviral activity or acting as carriers for promising microbicide drug candidates. Polymeric nanoparticles, in particular, have been shown to be able to enhance mucosal distribution and retention of promising antiretroviral compounds. One important aspect in the development of nanotechnology-based microbicides relates to the design of pharmaceutical vehicles that allow not only convenient vaginal and/or rectal administration, but also preserve or even enhance the performance of nanosystems. In this manuscript, we revise relevant work concerning the selection of vaginal/rectal dosage forms and vehicle formulation development for the administration of microbicide nanosystems. We also pinpoint major gaps in the field and provide pertinent hints for future work. Full article
(This article belongs to the Special Issue Novel Approaches for Delivery of Anti-HIV Drugs)
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18 pages, 1809 KiB  
Review
Gene Therapy Approaches to Functional Cure and Protection of Hematopoietic Potential in HIV Infection
by Tetsuo Tsukamoto
Pharmaceutics 2019, 11(3), 114; https://doi.org/10.3390/pharmaceutics11030114 - 11 Mar 2019
Cited by 4 | Viewed by 5091
Abstract
Although current antiretroviral drug therapy can suppress the replication of human immunodeficiency virus (HIV), a lifelong prescription is necessary to avoid viral rebound. The problem of persistent and ineradicable viral reservoirs in HIV-infected people continues to be a global threat. In addition, some [...] Read more.
Although current antiretroviral drug therapy can suppress the replication of human immunodeficiency virus (HIV), a lifelong prescription is necessary to avoid viral rebound. The problem of persistent and ineradicable viral reservoirs in HIV-infected people continues to be a global threat. In addition, some HIV-infected patients do not experience sufficient T-cell immune restoration despite being aviremic during treatment. This is likely due to altered hematopoietic potential. To achieve the global eradication of HIV disease, a cure is needed. To this end, tremendous efforts have been made in the field of anti-HIV gene therapy. This review will discuss the concepts of HIV cure and relative viral attenuation and provide an overview of various gene therapy approaches aimed at a complete or functional HIV cure and protection of hematopoietic functions. Full article
(This article belongs to the Special Issue Novel Approaches for Delivery of Anti-HIV Drugs)
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