Introduction:
The infiltration of HIV into the brain alters the functions of the nervous system known as NeuroAIDS. It leads to neuronal defects clinically manifested by motor and cognitive dysfunctions.
Materials/Methods:
Current antiretroviral therapy can prevent viral replication but cannot cure the disease completely.
HAART-Highly active antiretroviral therapy used for the treatment of HIV infection. Challenges in neuro-AIDS therapy
are as shown in the graphical abstract. One of the challenges is latent viral reservoirs like the brain; which acts as a
sanctuary site for viruses. Nearly ~50% of HIV patients show neuropathological signs. Nervous system related disorders
including AIDS dementia, sensory neuropathy, and myelopathy have a 25% of prevalence in patients having access to a
highly active combination antiretroviral therapy.
Results/Conclusions:
Brain is one of the viral sanctuary sites for HIV. The current need of neuro-AIDS therapy is to
target the brain as a viral reservoir. Drugs should cross or bypass the blood-brain barrier to reach the brain with effective
concentrations. Current research on novel drug delivery approaches may prove helpful to treat neuro-AIDS and related
disorders effectively.
Efavirenz is inhibitor of non-nucleoside reverse transcriptase enzyme; BCS class II drug. The objective of the present research was to prepare and evaluate nanosuspension of Efavirenz for the treatment of neuro-AIDS. Efavirenz is the substrate for drug resistant proteins at BBB prone to efflux and could not reach brain with effective levels. Current need of the therapy is to develop drug delivery systems targeting viral reservoirs at effective concentration in the brain. With this need we developed Efavirenz nanosuspension for nose to brain drug transport to bypass blood brain barrier. Nanosuspension prepared with high-pressure homogenization had a mean particle size of 223 nm, PDI of 0.2 and -21.2 mV zeta potential. Histopathology study on goat nasal mucosa showed no adverse effects of formulation on nasal tissues. Gamma scintigraphy study and
in-vivo
study on Wistar rat model reveals drug transport to the CNS after nasal administration. Pharmacokinetic parameters and drug targeting potential of 99.46 % suggest direct nose to brain transport of Efavirenz nanoparticle. Results reveal that nose to brain delivery of Efavirenz is the best possible alternative for neuro –AIDS treatment.
Nowadays, HIV associated neurological disorder especially HIV-1 virus infection is enhanced. Current available HIV therapies only reduce the plasma viral level and do not kill the virus completely. Administered dosage form does not reach the central nervous system (CNS) completely by the conventional approach. The oral route of drug administration,causes gastrointestinal irritation, hepatic metabolism and slow onset of action and some methods are invasive, resulting in the patient's non compliance. To overcome these problems, an effective novel formulation that will directly reach the CNS or brain needs to be developed.This study aims to formulate intranasal nanosuspension of ritonavir. Ritonavir is widely used as an antiretroviral agent and it is a protease enzyme inhibitor which is poorly soluble in water. High pressure homogenization technique was used for preparation prepare and optimization of nanosuspension by using 2 factors 3 level full factorial design, which is further characterized for particle size, polydispersity index, zeta potential, pH, drug content, in vitro drug diffusion and ex vivo permeation study. For stability of nanosuspension, lyophilization of optimized formulation was done. A comparison study between plain drug, nanosuspension and the lyophilized formulation was carried out, and it showed a significant increase in drug release from the membrane.
Background
The brain is the potential viral reservoir, and estimating the antiviral drug concentration in the brain is a hurdle to the researchers as very few animal models are available for this study. The objective of the study was to develop and validate the RP-HPLC method for the estimation of antiviral drug efavirenz (EFV) in the brain of healthy Wistar rats. EFV was the first-line antiretroviral medication. The optimized HPLC condition used for the analysis had the mobile phase methanol to water (9:1) ratio. The flow rate was set at 0.8 mL/min, while the detection wavelength was 248 nm.
Results
The retention time was found to be 5.7 min, and the % RSD was found within the limit. Recovery was found to be nearly 78%. The validation results were found to be within the limit range; hence, the obtained method was accurate, specific, rapid, and repeatable for estimation of EFV in the brain.
Conclusion
This method for estimation of EFV in the rat brain can be applicable for pharmacokinetic and toxicology study of EFV in the brain after administration of EFV to rats.
Graphical abstract
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