The transport of anti-HIV drugs across blood-CNS interfaces: summary of current knowledge and recommendations for further research.
The advent of highly active antiretroviral therapy (HAART), which constitutes HIV protease inhibitors, nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and nucleotide reverse transcriptase inhibitors, has dramatically reduced the morbidity and mortality associated with human immunodeficiency virus (HIV) infection in resource-rich countries. However, this disease still kills several million people each year. Though the reason for therapeutic failure is multi-factorial, an important concern is the treatment and control of HIV within the central nervous system (CNS). Due to the restricted entry of anti-HIV drugs, the brain is thought to form a viral sanctuary site. This not only results in virological resistance, but also is often associated with the development of complications such as HIV-associated dementia. The CNS delivery of anti-HIV drugs is limited by the blood-brain and blood-CSF interfaces due to a combination of restricted paracellular movement, powerful metabolic enzymes and numerous transporters including members of the ATP binding cassette (ABC) and solute carrier (SLC) superfamilies. A better appreciation of the transporters present at the brain barriers will prove a valuable milestone in understanding the limited brain penetration of anti-HIV drugs in HIV and also aid the development of new anti-HIV drugs and drug combinations, with enhanced efficacy in the CNS. This review aims to summarise current knowledge on the transport of anti-HIV drugs across the blood-brain barrier and the choroid plexus, as well as provide recommendations for future research.
Varatharajan
Lavanya
L
St George's Hospital, Cranmer Terrace, London SW17 ORE, UK.
Thomas
Sarah A
SA
D000818:Animals; D019380:Anti-HIV Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001692:Biological Transport; D001812:Blood-Brain Barrier / Q000187:drug effects; D049428:Blood-Nerve Barrier / Q000187:drug effects*; D015658:HIV Infections / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D026901:Membrane Transport Proteins / Q000378:metabolism
D019380:Anti-HIV Agents; D026901:Membrane Transport Proteins