Antiretroviral agents in pre-exposure prophylaxis: emerging and advanced trends in HIV prevention

Abstract

Objectives Antiretroviral agents (ARVs) have been the most promising line of therapy in the management of human immunodeficiency virus (HIV) infections. Some of these ARVs are used in the pre-exposure prophylaxis (PrEP) to suppress the transmission of HIV. Prophylaxis is primarily used in uninfected people, before exposure, to effectively prevent HIV infection. Several studies have shown that ART PrEP prevents HIV acquisition from sexual, blood and mother-to-child transmissions. However, there are also several challenges and limitations to PrEP. This review focuses on the current antiretroviral therapies used in PrEP. Key findings Among ARVs, the most common drugs employed from the class of entry inhibitors are maraviroc (MVC), which is a CCR5 receptor antagonist. Other entry inhibitors like emtricitabine (FTC) and tenofovir (TFV) are also used. Rilpivirine (RPV) and dapivirine (DPV) are the most common drugs employed from the Non-nucleoside reverse transcriptase inhibitor (NNRTIs) class, whereas, tenofovir disoproxil fumarate (TDF) is primarily used in the Nucleoside Reverse Transcriptase Inhibitor (NRTIs) class. Cabotegravir (CAB) is an analog of dolutegravir, and it is an integrase inhibitor. Some of these drugs are also used in combination with other drugs from the same class. Summary Some of the most common pre-exposure prophylactic strategies employed currently are the use of inhibitors, namely entry inhibitors, non-nucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors, integrase and protease inhibitors. In addition, we have also discussed on the adverse effects caused by ART in PrEP, pharmacoeconomics factors and the use of antiretroviral prophylaxis in serodiscordant couples.HIV and pre-exposure prophylaxis Pui Khee Yap et al.

Implementing PrEP to Decrease HIV Transmission Rates Among Females

“…TDF/FTC inhibits a process called reverse transcriptase by preventing the conversion of HIV RNA into HIV DNA, which will slow and prevent viral replication. 1,36 To obtain adequate protection and reach maximum concentration in the blood and cervicovaginal tissue, it needs to be Have had more than 1 sexual partner (either oral, vaginal, or anal) since their last HIV test Have had a sexual encounter with a man who has sex with men Have had a sexual encounter with another person without a condom/barrier Have engaged in sex for drugs or money Is currently or has been with a person who injects drugs Are sex partners of HIV-infected persons Has had treatment for a sexually transmitted infection Sources: American College of Obstetricians and Gynecologists, 18 Owens et al, 19 and Chou et al 20 taken daily for at least 20 days. 36 AFAB who engage in receptive anal sex receive maximum concentration in rectal tissues after 7 days of continuous TDF/FTC.…”

“…This is due to its long intracellular halflife and high concentrations in rectal tissue. 30,36 Although not FDA approved, trials have shown that TDF alone demonstrated efficacy and safety when combined with barrier contraception use, diagnosis and treatment of sexually transmitted infection, and sexual risk reduction counseling. TDF alone was proven effective for high-risk people that engage in sexual activity that includes penis-to-vagina contact and persons who inject drugs.…”

Overactivation of the sodium–calcium exchanger and transient receptor potential in anesthesia‐induced malignant hyperthermia

“…The TRPN (NOMP‐C homologs) subgroup of proteins is not found in well‐evolved creatures, yet they are communicated in spineless creatures, for example, flies and worms and every subfamily has at least one members. All TRP channels are cation‐particular, with some being exceedingly specific for Na + , Ca 2+ , and Mg 2+ . TRPCs have additionally been proposed as mediators of extracellular Ca 2+ entry in skeletal muscle .…”

Mitochondrial Toxicogenomics for Antiretroviral Management: HIV Post-exposure Prophylaxis in Uninfected Patients

“…To avoid these adverse effects, other NRTIs such as Tenofovir (TDF) emerged (Scherzer et al, 2012;Margolis et al, 2014;Yap et al, 2019). TDF in combination with Emtricitabine (FTC), another NRTI, constitutes the main 2xNRTI combination included in the ART proposed by the main institutions (Centers for Disease Control Prevention, 2016; Battegary et al, 2018;World Health Organization, 2018).…”

“…Despite the main goal of ART being the treatment of HIV infection, these drugs may also be used to prevent vertical mother-to-child transmission or can also be administered as pre-exposure or post-exposure prophylaxis (PrEP or PEP, respectively, Yap et al, 2019). PEP involves counseling, assessment of risk of exposure to the infection, HIV testing, and the prescription of a 1-month course of antiretroviral drugs with appropriate support and follow-up (Katz and Gerberding, 1997;Chauveau et al, 2019).…”