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Authored by: B V Waghmare

Monday, September 5, 2011

Anti retroviral drugs of class protease inhibitors drugs and increased blood cholesterol level.

Antiretroviral drugs belonging to class protease inhibitors are known to cause increase in cholesterol level in patients taking protease inhibitors drugs. Anti retroviral protease inhibitors drugs which act by inhibiting enzyme protease , this enzyme helps HIV virus in building its protein by breaking higher proteins in to smaller on, and then make use of these smaller one for building HIV and viral envelop and thus help in reproduction of HIV virus.

Every drug do not specifically act on a particular system, but they do have some varied degree of action on other metabolic and biochemical systems and cycles, antiretroviral drug belonging to category protease inhibitors cause increase in cholesterol, in a broader term this class of drug may cause hypertriglyceridemia, hypercholesterolemia and the increased cholesterol level in patients and subject them to high risk of developing atherosclerosis, by increasing the level atherogenic lipoproteins and endothelial dysfunction which increase the risk of atherosclerosis and heart disease.

Drug Norvir, is known to cause more hyperlipidemia compared to other protease inhibitor drugs . Also a non protease drug Sustiva is also known to increase blood lipid levels. Other underlying factors like smoking , alcohol consumption , and low physical activity , which affect lipid metabolism and are responsible for increased blood cholesterol level must be considered , there is great risk of developing hyperlipidemia with those underlying factors.Patient are advised to quite smoking and do some physical exercise regularly, must avoid alcohol.

What is done when a patient develop hyperlipidemia :
Hyperlipidemia associated with protease inhibitors is a reversible type which means it ceases if changes are made in antiretroviral drugs to treat hyperlipidemia, doctor decide up on consideration of the risk of hyperlipidemia compared to viral count and patients health, hyperlipidemia is also managed with exercise and altering the food to low fat diet.

Incase of sever conditions following drugs which lower blood cholesterol are given
Statins : Lipitor (atorvastatin) and Pravachol (pravastatin).
Fibrates: Lopid (gemfibrozil) and Tricor (fenofibrate)

All above drugs have serious side effects in high dose and long term , for example, drug belonging to group statins are known to cause rhabdomyolysis and drug belonging to group Fibrates are known to increase risk of developing gall stone.

Source:
http://www.jci.org/articles/view/16261#B5

http://www.aidsinfo.nih.gov/contentfiles/Hyperlipidemia_FS_en.pdf

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Authored by :  B V Waghmare

Last updated: 06-Sep-2011

Tuesday, August 30, 2011

HIV vaccine research, B Cells can be stimulated with proteins on HIV virus region which do not change and produce antibodies which can neutralize HIV virus.

National institute of health led researchers found route to guide B cells to produce antibodies against HIV which can neutralize HIV the research provides a clue for development of HIV vaccine. .

Days are not far when researchers will be successful in developing a vaccine for HIV, so far there is no vaccine available against HIV, in last few years HIV vaccine research has seen many setbacks and failures, researchers too have learned from those failures, we too strongly believe that a vaccine for HIV is just not a dream but it is a possibility. HIV vaccine will be of great importance when combined with other drugs. A hope comes from the fact that there lies a region on HIV which do not show much variation which is known as cd4 binding site, developing proteins similar to those regions which can be used to evoke B cells for production of antibodies against HIV which can neutralize HIV virus and thus can be used as vaccine against HIV.

The process of developing a vaccine for HIV is not less than solving a puzzle, where it is required to unwind lot of facts about the process and mechanism with which HIV infect and replicate in human body, the enzyme systems and the genetic constitution of each and every HIV strains, and finding how HIV antigens are recognized by human immune system, how genes code for proteins which can neutralize HIV virus, and how to present these proteins to human immune system so that it can stimulate the production of antibodies against incoming HIV virus which they can neutralize by binding with it, so that, those proteins can be used as vaccine.

Scientists at Vaccine Research Center (VRC) and the National Institute of Allergy and Infectious Diseases (NIAID) which is a part of National Institutes of Health, are successful in finding the facts about how some HIV neutralizing antibodies are developed in human body, they have found the map or route with which human B cells can develop a immune response which can trigger production of antibodies against HIV virus which can successfully neutralize HIV virus by binding with it.

One of the interesting fact about this discovery is that variation in genetic material of HIV occurs due to greater degree of mutation in HIV in all strains, which is a biggest hurdle in developing an effective vaccine against HIV, which makes virus to change its genes which are then difficult to recognize by human body in event of encounter with HIV virus. A hope comes from the fact that there lies a region on HIV which do not show much variation which is known as cd4 binding site.

Last year VRC scientists discovered three antibodies of which two antibodies can stop HIV from infecting humans by neutralizing HIV virus, these antibodies can stop almost ninety percent of known HIV strains from infecting humans.

These antibodies were named as VRC01, VRC02 and VRC03 , these antibodies against HIV were found in blood sample of North American named as donor 45 , further in a new study researchers found antibodies similar to VRC01 in the blood donated by two Africans which were already infected with HIV they were called as donor 74 and donor 0219.

Scientists found that the genes which code for VRC01 protein are present over DNA in B cells, which are responsible for imparting immunity our body. These gens are responsible for coding VRC01 like proteins which can neutralize HIV virus.

Scientists studied the gens responsible for coding VRC01 by method known as deep sequencing, this method is used first time in HIV vaccine research to find the path way of evolution of the antibody response to HIV virus to genetic level. Scanning of B-cell DNA libraries of donor 45 and donor 74 was done, and the genes which code for HIV neutralizing antibodies were grouped at one place.

Further researchers studied the gene segment which coded for the part of VRC01-like antibody which binds to HIV virus and neutralize. Study of sequence in new found relative genes which code VRC01 discovered how step by step changes in the sequence turned it to into a mature form. A vaccine which evoke VRC01-like antibodies is required to coax the B-cell DNA of immature antibodies to evolve along one of these pathways.

Researchers are now focused on developing proteins which will guide B Cells step by step , guide them towards develop a immune response for formation of antibodies against HIV which can neutralize HIV virus in the same manner as that of VRC01 antibodies.


Source: http://www.niaid.nih.gov/news/newsreleases/2011/Pages/HIVAntibodyEvolution.aspx

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Last updated:30-Aug-2011

Authored by: B V Waghmare.



Saturday, July 9, 2011

Testing for HIV infection

Tests for HIV are used to detect the presence of HIV infection in ones body, the tests can detect the HIV in blood , urine and saliva , the main principle behind these tests are detection of HIV antibodies, antigen or RNA of HIV. And the tests employed for detection are

1. ELISA

2. Western Blot

3.Polymerase Chain Reaction.

4.Rapid point of care test kits

A. Home Access Express HIV-1 Test
B. OraQuick this test can be applied on saliva or oral swabs.
C. Orasure
D. Uni-Gold
E. Clearview Complete HIV 1/2 and Clearview HIV 1/2 Stat-Pak
F. INSTI™ HIV-1 Antibody Test is the latest test available to which gives result in 60 seconds.
G. Reveal HIV

If ELISA or other point of care test is positive the test result must be confirmed with Western Blot, ELISA test alone can not be used for confirmation of positive result. PCR test involves direct detection of HIV RNA which is considered highly accurate.

When a test result for HIV is false negative? (actually HIV positive but tests show negative results)

Result of the HIV test may be negative or false negative immediately after encountering the HIV infection as seroconversion do not occur immediately it may take about 30 days to develop antibodies against HIV, in certain cases it may take longer time therefore if the person has not taken any medication should be tested immediately after 30 days, if he is tested positive a confirmatory test must be done, even if the patient is tested negative the test should be conducted again after a period of 30 days, if there is a history of risk of getting HIV infection in the patient they should be given pre exposure prophylactic drugs for HIV until further confirmatory test are done.

If a person has taking post exposure prophylactic medications for HIV, then the test may not give positive result even after 30 days, therefore the person should be advised to do test again after period of 30 days for about seven to eight months without discontinuing the medications.

Information about Various tests for HIV

The ARCHITECT HIV Ag/Ab Combo Assay: This HIV test is capable of identifying HIV infection in early stage as it detects both HIV 1 antigen p24 and antibodies hence helps in early detection of HIV infection

There are many tests kits available in market which are used as rapid HIV testing kits, which are used as the point of care tests kits, they are used in hospitals and other places where it is required to find out if a person is HIV positive or not, not only blood sample but the saliva and urine can be used with these test kits for knowing if a person is HIV positive or not, all positive results obtained with the rapid test kit tests must be confirmed with Western Blot. One must take up the regular tests like ELISA followed by Western Blot or PCR for confirmation of HIV testing results.


HIV infection and AIDS is on of the disease which has affected millions of homes world wide , and if we do not work today to prevent HIV it will be a biggest enemy of mankind.
There is only one effective way to protect every on from getting HIV infection is to educate every one about how HIV is spread from one individual to other and how it is not transmitted.
The most important aspect of HIV prevention is getting HIV test done, it is very difficult to convince people to get HIV testing done, they should be encouraged to take up HIV testing if they are more susceptible for getting HIV infection.
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Source:
Lists of tests for HIV screening

HIV Testing/resources/qa

OraQuick Rapid Tests for HIV

FDA approved rapid antibody tests for HIV 

PCR test for HIV nucleic acid detection
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Refer following pages for detailed information on HIV virus and Its prevention and AIDS symptoms  HIV symptoms and research



Tuesday, May 31, 2011

New nonnucleoside reverse transcriptase inhibitors for treating patients who never recived any anti retroviral drug before

New drug is now available for HIV positive patients who have never taken any treatment.

There is a new drug development in the treatment of HIV positive individual, now a new drug is approved by US food and drugs administration , the new drug is a non nucleoside reverse transcriptase inhibitor, which can be used to lower the higher HIV 1 viral load in blood of HIV positive individuals which never received any anti retroviral treatment before, as the task is a challenging one the newly available drug will be able to provide better tratement option in such cases along with HAART.

Brand name of this drug is Edurant which contains rilpivirine, Raritan, N.J-based Tibotec Therapeutics, a division of Centocor Ortho Biotech Inc has developed this drug.

Rilpivirine
The drug molecule rilpivirine is a diarylpyrimidine derivative which resembles the pyrymidine nucleotides in complementroy DNA and tymine nucleotide in RNA in HIV virus  which, owing to its similarity to the chemical resemblance to pryamidine nucleotides, It act by inhibiting HIV virus replication, by blocking enzyme reverse transcriptase. Rilpivirine drug molecule also exhibit some level of conformational isomerism which make this drug molecule to bind with pryrimidine nucleosides strongly preventing them from replication, making this drug molecule active even in higher HIV viral load conditions.

Nucleotide reverse transcriptase inhibitor drugs have therapeutic index to a lower side (moderate) compared to non nucleoside reverse transcriptase inhibitors, that means they nonnucleoside reverse transcriptase inhibitors posses less toxic side effects than nucleotide reverse transcriptase inhibitor drugs , although there is greater likely hood of developing drug resistance in case of nonnucleocide reverse transcriptase inhibitors, the drug should not be discontinued once it is started and a desired low viral level is maintained throughout. There are also some drug resistance assays available with which one can predict the likely hood of drug resistance with a particular antiretroviral drug.

Edurant rilpivirine is approved by US food and drugs administration as a drug to be used in a highly active antiretroviral therapy (HAART) regimen which is targeted to reduce the HIV virus load in the infected individual . The dose of the drug is once a day pill taken with food.

The drug can be used in patients who had not received any prior HIV therapy as the drug Edurant (rilpivirine) in a clinical trail effectively reduced the initial higher HIV viral load in the blood of infected individuals to a level of HIV virus undetectable level is blood.

Side effects include (insomnia) difficulty sleeping, headache,depression, and rash.
The drug Edurant(rilpivirine) do not cure HIV or AIDS ( no drug in the world cure HIV AIDS rather they help in improving quality of life and extending life) therefore US FDA has advised patients to stay on with continuous with their therapy for HIV and related diseases. and other AIDS symptoms

Source:
http://aac.asm.org/cgi/content/full/48/10/3684?view=long&pmid=15388420

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm256087.htm




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