Cellular issues relating to the resistance of HIV to antiretroviral agents.
It has been proposed that the declining efficiency of antiretroviral agents in human immunodeficiency virus (HIV) infection may also depend on cellular factors at their site of action. Two in particular have been proposed: (i) the defective intracellular metabolism of NRTI in target cells and the altered uptake; and (ii) efflux of nucleoside reverse transcriptase inhibitors (NRTI) and protease inhibitors (PI) by cellular transporter molecules. Several studies have shown that: changes in the activities of various purine and pyrimidine biosynthetic enzymes may occur in lymphocytes of HIV-infected patients; HIV-infected patients on prolonged treatment with nucleoside analogues, e.g. zidovudine, show significantly decreased activity of thymidine kinase (TK) compared with untreated HIV-infected people; and NRTI and PI are substrates for the multidrug membrane transporters. With regard to the latter issue, it is known that the ATP-binding cassette transporter proteins such as the P-glycoprotein (MDR), and the newly discovered family of multidrug resistance-associated proteins (MRP1-6), promote the active extracellular efflux of a wide variety of therapeutics drugs and overexpression of some of them lowers intracellular concentration of PI. In the very near future such mechanisms, also called 'cellular drug resistance', might be taken into account, together with other immunological, virological and behavioural factors, to explain the 'drug failure' and/or the variability of response in HIV patients undergoing antiretroviral treatment.
Department of Experimental Medicine and Pathology, Virology Section, University La Sapienza', Rome, Italy.
Ombretta
O
Turriziani
Carolina
C
Scagnolari
Francesca
F
Bellomi
Isabella
I
Solimeo
Federico
F
Focher
Guido
G
Antonelli
D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000188:drug therapy; D019380:Anti-HIV Agents / Q000494:pharmacology*; D001693:Biological Transport, Active / Q000187:drug effects / Q000502:physiology; D002478:Cells, Cultured; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy; D017320:HIV Protease Inhibitors / Q000378:metabolism* / Q000494:pharmacology; D015497:HIV-1 / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009705:Nucleosides / Q000378:metabolism* / Q000494:pharmacology; D018894:Reverse Transcriptase Inhibitors / Q000378:metabolism* / Q000494:pharmacology; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D009705:Nucleosides; D018894:Reverse Transcriptase Inhibitors