The intracellular pharmacology of antiretroviral protease inhibitors

• Published in: Journal of antimicrobial chemotherapy Vol. 54; no. 6; pp. 982 - 990
• Main Authors: Ford, J., Khoo, S. H., Back, D. J.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-12-2004; Oxford Publishing Limited (England)
• Subjects: Antibiotics. Antiinfectious agents. Antiparasitic agents; ATP-Binding Cassette, Sub-Family B, Member 1 - metabolism; Biological and medical sciences; Drug Monitoring - methods; efflux; HIV; HIV Infections - drug therapy; HIV Infections - virology; HIV Protease Inhibitors - metabolism; HIV Protease Inhibitors - pharmacokinetics; HIV Protease Inhibitors - pharmacology; HIV-1 - drug effects; Human immunodeficiency virus; Humans; influx; Leukocytes, Mononuclear - cytology; Leukocytes, Mononuclear - drug effects; Leukocytes, Mononuclear - metabolism; Leukocytes, Mononuclear - virology; Medical sciences; P-glycoprotein; pharmacokinetics; Pharmacology. Drug treatments; Infection; Immunopathology; Antiretroviral agent; Viral disease; Antiviral; AIDS; Pharmacology; Intracellular; Immune deficiency; Protease inhibitor
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkh487

Therapeutic drug monitoring (TDM) of antiretroviral protease inhibitors (PIs) has been suggested to have the potential to both reduce toxicity and optimize individual therapy. However, the major target of PIs is within cells infected with HIV. Therefore clinical outcome ultimately must be related to intracellular drug concentrations since antiviral activity of PIs is highly correlated with intracellular concentrations in vitro. Intracellular pharmacokinetics provides information regarding drug disposition in a compartment where HIV replication occurs and combined with plasma data may be useful in understanding therapeutic failure in relation to cellular resistance. In order to improve therapeutic efficacy, it is therefore important that the intracellular pharmacokinetics of drugs, such as PIs, is studied in addition to plasma pharmacokinetics. Multidrug resistance transporters may result in a lower cellular concentration of drug via an efflux mechanism, thus contributing to sanctuary site formation. However, conclusive proof that transporters contribute to clinical drug resistance is still lacking, although recent studies have attempted to address this issue. In relation to host and cellular factors, this review considers several issues involved in influencing intracellular drug concentrations and discusses the intracellular levels of PIs recently published from cellular studies.