Stavudine Ritonavir

Melino S, Paci M (2007) Progress for dengue virus diseases. Towards the NS2B-NS3pro inhibition for a therapeutic-based approach. FEES J 274 2986-3002 Murphy RL, Brun S, Hicks C, Eron JJ, GuUck R, King M, White AC Jr, Benson C, Thompson M, Kessler HA, Hammer S, Bertz R, Hsu A, Japour A, Sun E (2001) ABT-378/ritonavir plus stavudine and lamivudine for the treatment of antiretroviral-naive adults with HIV-1 infection 48-week results. AIDS 15 E1-E9... 

Atazanavir or fosamprenavir or nelfinavir or saquinavir/ ritonavir, and zidovudine or stavudine or tenofovir or abacavir or didanosine, and lamivudine or emtricitabine... 

Drugs that should not be combined due to overlapping toxi-cities include amprenavir oral solution plus ritonavir oral solution, atazanavir plus indinavir (due to enhanced hyperbilirubinemia), and any combination of didanosine, stavudine, and zalcitabine. Emtricitabine and lamivudine should not be combined because of their similar chemical structures, and antagonism can result when lamivudine is combined with zalcitabine, or stavudine is combined with zidovudine. 

TC, lamivudine ABC, abacavir APV, amprenavir AST, aspartate aminotransferase ALT, alanine aminotransferase ATV, atazanavir CBC, complete blood cell count D/C, discontinue ddl, didano-sine d4T, stavudine EFV, efavirenz FTC, emtricitabine P1BV, hepatitis B virus F1CV, hepatitis C vims HIV, human immunodeficiency virus IDV, indinavir IV, intravenous LFT, liver function tests LPV/r, lopinavir + ritonavir NNRTI, nonnucleoside reverse transcriptase inhibitor NRTI, nucleoside reverse transcriptase inhibitor NVP, nevirapine PI, protease inhibitor PT, prothrombin time T.bili, total bilirubin TDF, tenofovir disoproxiI fumarate TPV, tipranavir ULN, upper limit of normal ZDV, zidovudine. 

Peptidases encoded by many viruses play essential roles at various stages of viral replication, including the coordinated assembly and maturation of virons [7a]. Viral peptidases have become important drug targets in the treatment of viral infections. Of note are inhibitors of proteases of the human immunodeficiency virus (HIV), particularly HIV-1 protease (HIV-1 retropepsin, EC 3.4.23.16) and HIV-2 protease [47-50], Drugs in this class, which include indinavir, ritonavir, and saquinavir, are useful in the treatment of AIDS, especially when administered as a cocktail together with one of the drugs that act on the viral retrotranscriptase (e.g., didanosine, stavudine, and zidovudine (AZT)). 

Drugs that may affect zidovudine include acetaminophen, atovaquone, bone marrow suppressive/cytotoxic agents (eg, adriamycin, dapsone), clarithromycin, doxorubicin, fluconazole, ganciclovir, methadone, nelfinavir/ritonavir, phenytoin, probenecid, ribavirin, rifamycins, stavudine, trimethoprim, and valproic acid. 

TC Lamivudine ABC Abacavir d4T Stavudine ddC Zalcitabine ddl Didanosine TDF Tenofovir ZDV Zidovudine, also abbreviated as AZT FTC Emtricitabine NVP Nevirapine DLV Delavirdine EFV Efavirenz RTV, r Ritonavir Pl/r Ritonavir boosted protease inhibitor SQV Saquinavir IDV Indinavir LPV Lopinavir NEV Nelfinavir APV Amprenavir ATV Atazanavir DRV Darunavir... 

Atazanavir Ritonavir Fosamprenavir, didanosine, efavirenz, etravirine, stavudine, tenofovir... 

Cushing s syndrome occurred in a 44-year-old HIVpositive patient who used inhaled fluticasone (500 micrograms qds) for severe asthma for 2 years (153). Stavudine and nevirapine were replaced by abacavir and ritonavir + lopinavir and 2 months later he developed the typical features of Cushing syndrome. 

A 36-year-old HIV-infected woman who had been receiving stavudine, saquinavir, ritonavir, and didanosine developed lactic acidosis (serum lactate 11.4 mmol/1) and hepatomegaly. She had acute pancreatitis and, despite ventilatory support for respiratory failure, died after 8 weeks. 

At the present time, there are at least 14 compounds that have been formally approved for the treatment of human immunodeficiency virus (HIV) infections. There are six nucleoside reverse transcriptase inhibitors (NRTIs) that, after their intracellular conversion to the 5 -triphosphate form, are able to interfere as competitive inhibitors of the normal substrates (dNTPs). These are zidovudine (AZT), didanosine (ddl), zalcitabine (ddC), stavudine (d4T), lamivudine (3TC), and abacavir (ABC). There are three nonnucleoside reverse transcriptase inhibitors (NNRTIs) — nevirapine, delavirdine, and efavirenz — that, as such, directly interact with the reverse transcriptase at a nonsubstrate binding, allosteric site. There are five HIV protease inhibitors (Pis saquinavir, ritonavir, indinavir, nelfinavir, and amprenavir) that block the cleavage of precursor to mature HIV proteins, thus impairing the infectivity of the virus particles produced in the presence of these inhibitors. 

Zidovudine/lamivudine plus either Ritonavir 600 mg twice daily Didanosine/stavudine Saquinavir soft gel 1,200 mg three times daily... 

Abacavir — Adefovir — Amprenavir1 — Delavirdine — Didanosine (ddl) — Efavirenz — Indinavir1 — Neirinavir — Nevirapine1 — Ritonavir — Saquinavir1 — Stavudine (d4T) — Zalcitabine (ddC) — Zidovudine (AZT)... 

A 49-year-old HIV-positive Caucasian man had taken ritonavir (400 mg bd), saquinavir (400 mg bd), and stavudine (40 mg bd) for 4 months. His CD4 cell count was 617 x 106 cells/1 and HIV-1 RNA less than 400 copies/ml. He had previously taken zidovudine for 7 months. He self-injected twice with metamfetamine and sniffed amyl nitrite and was found dead a few hours later. At autopsy, there was no obvious cause of death. Metamfetamine was detected in the bile (0.5 mg/1) and cannabinoids and traces of benzodiazepines were detected in the blood. 

Preferred Pl-based regimens are lopinavir/ritonavir plus lamivudine or emtricitabine plus another NRTI, usually zidovudine, stavudine or abacavir. Alternative combinations include other Pis with or without ritonavir, and two NRTIs. The combination of a protease inhibitor with ritonavir provides inhibition of cytochrome p450 enzymes and permits less frequent dosing of amprenavir, indinavir, lopinavir and saquinavir. Use of ritonavir in this setting is also known as boosting. ... 

A 46-year-old man with prosthetic cardiac valves took acenocoumarol and later started to take stavudine, lamivudine, and ritonavir 600 mg bd. His INR fell markedly. Although the dose of acenocoumarol was progressively increased to three times the original dose, it was impossible to achieve the previous INR, and ritonavir was withdrawn. 

System affected by the adverse event Stavudine + nevirapine -t ritonavir (n = 41) Stavudine + nevirapine -t nelfinavir (n = 44) Stavudine + lamivudine -t nevirapine -t nelfinavir (n = 44) Stavudine + lamivudine + nelfinavir (n = 52)... 

HPI CJ is a 32-year-old man with acquired immunodeficiency syndrcMne (AIDS) (CD4+ cell count 160 cells/mm viral load 35,000 copies/mL) who presents to the clinic with altered taste sensation and difficulty swallowing. G is noted to have white plaques on the tongue and upper oral pharynx that are easily scraped off with a tongue depressor. PMH is significant for renal insufficiency secondary to his HIV. His antiretroviral regimen includes stavudine, lamivudine, and lopinavir/ritonavir and he is receiving TMP-SMX for Pneumocystis carinii pneumonia (PCP) prophylaxis. He has NKDA. 

Successful treatment of human immunodeficiency virus (HIV-1) infection has been achieved through successful implementation of highly active antiretroviral therapy, frequently referred to as HAART. This involves simultaneous administration of both nucleoside and nonnucleoside reverse transcriptase inhibitors and one or more protease inliibitors. The common nucleoside reverse transcriptase inhibitors are the thymidine analogs didanosine (ddl), lamivudine (3TC), and zalcitabine (ddC) and the non-thymidine analogs abacavir (Ziazen), stavudine (d4T), and zidovudine (AZT). The nonnucleoside reverse transcriptase inhibitors include delavirdine, efavirenz, and nevirapine. The protease inhibitors include indinavir, nelfinavir, ritonavir, and saquinavir. Response to therapy is monitored by quantification of HIV-RNA copies (viral load) and CD-4+ T-lymphocyte count. Successful therapy is indicated when viral load is reduced to <50 copies/mL and CD-4+ count >500 per mL. 

Preferred Lopinavir/ritonavir plus lamivudine plus zidovudine (or stavudine)... 

Atazanavir plus lamivudine (or emtricitabine) plus zidovudine (or stavudine) Indinavir-ritonavir plus lamivudine (or emtricitabine) plus zidovudine (or stavudine) Lopinavir-ritonavir p/us emtricitabine plus zidovudine (or stavudine)... 

ABBREVIATIONS EFV, efavirenz 3TC, lamivudine AZT, zidovudine TDF, tenofovir disoproxil fumarate d4T, stavudine LPV/r, lopinavir/ritonavir coformulation FTC, emtricitabine NVP, nevirapine ddl, didanosine ATV, atazanavir fosAPV, fosamprenavir RTV, ritonavir IDV, indinavir NFV, nelfinavir SQV, saquinavir. 

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