Objectives
Long-acting nanoformulated antiretroviral therapy (nanoART) with improved pharmacokinetics, biodistribution and limited systemic toxicities will likely improve drug compliance and access to viral reservoirs.
Design
Atazanvir and ritonavir crystalline nanoART were formulated in a poloxamer-188 excipient by high-pressure homogenization. These formulations were evaluated for antiretroviral and neuroprotective activities in humanized NOD/scid-IL-2Rgcnull (NSG) mice.
Methods
NanoART-treated NSG mice were evaluated for drug biodistribution, pharmacodynamics and nanotoxicology. CD34+ human hematopoietic stem cells were transplantation at birth in NSG mice. The mice were infected with HIV-1ADA at 5 months of age and 8 weeks later, infected animals were treated with weekly subcutaneous injections of nanoformulated ATV and RTV. Peripheral viral load, CD4+ T cell count, lymphoid tissue and brain pathology were evaluated.
Results
NanoART treatments by 6 once a week injections reduced viral loads >1000 fold and protected CD4+ T cell populations. This paralleled high ART levels in liver, spleen and blood that were in or around the human minimal effective dose concentration without notable toxicities. Importantly, examination of infected brain subregions showed that nanoART elicited neuroprotective responses with detectable increases in microtubule-associated protein-2, synaptophysin and neurofilament expression when compared to untreated virus-infected animals. Therapeutic interruptions produced profound viral rebounds.
Conclusions
Long-acting nanoART has translational potential with sustained and targeted efficacy and with limited systemic toxicities. Such success in drug delivery and distribution could improve drug adherence and reduce viral resistance in infected people.