Alternative modes of antiretroviral administration are sought for people with impaired intestinal passage and/or absorption. We present a case of late HIV diagnosis (CD4+ count 160 cells/µL) with gastric outlet obstruction due to stomach adenocarcinoma. Co-morbidities included oesophageal candidiasis, Helicobacter pylori-positive duodenal ulcers and cytomegalovirus duodenitis. The gastric outlet obstruction required total parenteral nutrition and parenteral medication during four weeks of diagnostic work-up leading to pyloric resection. Crushed dolutegravir, abacavir and lamivudine were administered during this time in the evening via nasogastric tube, which was kept clamped overnight. The tube was unclamped in the morning and stomach content was drained during the daytime. This mode of administration resulted in rapid and sustained viral load suppression (from 300,000 to 115 copies per mL in 28 days, 81 copies/mL after 42 days of treatment and less than 40 copies/mL thereafter). Therapeutic drug monitoring confirmed sufficient antiretroviral plasma levels during this mode of administration. The absorption of crushed dolutegravir, abacavir and lamivudine in the stomach may be considered in people with questionable gastrointestinal passage or impaired gastric emptying to achieve viral load suppression.
- MeSH
- adenokarcinom komplikace MeSH
- antiretrovirové látky terapeutické užití MeSH
- dideoxynukleosidy aplikace a dávkování terapeutické užití MeSH
- gastrointestinální intubace MeSH
- heterocyklické sloučeniny tricyklické aplikace a dávkování terapeutické užití MeSH
- HIV infekce diagnóza farmakoterapie MeSH
- lamivudin aplikace a dávkování terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory žaludku komplikace MeSH
- obstrukce vyprazdňování žaludku komplikace MeSH
- parenterální výživa MeSH
- setrvalá virologická odpověď MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE: The purpose of this study was formulation and optimization of vaginal film formulation containing abacavir (ABC), a potent nucleoside reverse transcriptase inhibitor. METHODS: Vaginal films were prepared by solvent evaporation method using hydroxypropyl methylcellulose (HPMC) blended with polyvinyl pyrrolidone (PVP). Various physicochemical parameters of the prepared films such as drug content, thickness, tensile strength, percentage elongation at break, drug polymer interaction, swelling capacity, folding endurance, bio-adhesion, pH, and moisture content were evaluated with morphological studies. In vitro release study and in vivo release study were also performed. RESULTS: Films exhibited favorable physicochemical properties. The in vitro study showed that HPMC-PVP combination can control the release of abacavir through vaginal films with higher amount of PVP in the formulation resulting in an enhanced drug release rate. During the in vivo study in rabbits, systemic absorption of the drug was noted and the films remained intact for long in vagina without causing any sort of irritations. CONCLUSION: Thus, in a nutshell, the findings of our experimental work indicate that such films can be considered as a novel drug carrier system for the treatment of AIDS and other sexually transmitted diseases (STDs), and are suitable for local as well as systemic effects.
- MeSH
- aplikace intravaginální MeSH
- chemické jevy MeSH
- dideoxynukleosidy aplikace a dávkování farmakokinetika MeSH
- králíci MeSH
- látky proti HIV aplikace a dávkování farmakokinetika MeSH
- lékové formy * MeSH
- nosiče léků aplikace a dávkování chemie MeSH
- příprava léků * MeSH
- uvolňování léčiv * MeSH
- zvířata MeSH
- Check Tag
- králíci MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- STAVUDIN (BRISTOL-MYERS SQUIBB),
- MeSH
- dideoxynukleosidy aplikace a dávkování kontraindikace škodlivé účinky MeSH
- HIV infekce farmakoterapie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
