Overcoming pharmacologic sanctuaries

Theodore Cory, Timothy W. Schacker, Mario Stevenson, Courtney V. Fletcher

Research output: Contribution to journalReview article

72 Citations (Scopus)

Abstract

PURPOSE OF REVIEW: Current antiretroviral treatment regimens represent significant improvements in the management of HIV-1 infection; however, these regimens have not achieved a functional or sterilizing cure. One barrier to achieving a cure may be suboptimal antiretroviral concentrations in sanctuary sites throughout the body, including the central nervous system, gut-associated lymphoid tissue, lymph nodes, and tissue macrophages. This review will focus on the problems associated with achieving effective concentrations in these restricted sanctuary sites, and potential strategies to overcome these barriers. RECENT FINDINGS: Sufficient data exist to conclude that antiretroviral drug distribution is not uniform throughout the body. Low tissue/reservoir concentrations may be associated with viral replication. Multiple means to increase drug concentrations in sanctuary sites are being investigated, including modification of currently utilized drugs, blockade of transporters and enzymes that affect drug metabolism and pharmacokinetics, and local drug administration. Accumulating data suggest these methods increase antiretroviral concentrations in reservoirs of viral replication. No method has yet resulted in the complete clearance of HIV. SUMMARY: New strategies for increasing antiretroviral concentrations in predominant sites of viral replication may provide more effective means for elimination of viral sanctuaries. Additional research is necessary to optimize antiretroviral tissue distribution in order to inhibit virus replication fully, and avoid resistance and replenishment of viral reservoirs that may persist in the face of antiretroviral therapy.

Original languageEnglish (US)
Pages (from-to)190-195
Number of pages6
JournalCurrent Opinion in HIV and AIDS
Volume8
Issue number3
DOIs
StatePublished - May 1 2013

Fingerprint

Pharmaceutical Preparations
Lymphoid Tissue
Tissue Distribution
Virus Replication
HIV Infections
HIV-1
Central Nervous System
Pharmacokinetics
Lymph Nodes
Macrophages
HIV
Enzymes
Research
Therapeutics

All Science Journal Classification (ASJC) codes

  • Immunology
  • Hematology
  • Oncology
  • Oncology(nursing)
  • Infectious Diseases
  • Virology

Cite this

Overcoming pharmacologic sanctuaries. / Cory, Theodore; Schacker, Timothy W.; Stevenson, Mario; Fletcher, Courtney V.

In: Current Opinion in HIV and AIDS, Vol. 8, No. 3, 01.05.2013, p. 190-195.

Research output: Contribution to journalReview article

Cory, T, Schacker, TW, Stevenson, M & Fletcher, CV 2013, 'Overcoming pharmacologic sanctuaries', Current Opinion in HIV and AIDS, vol. 8, no. 3, pp. 190-195. https://doi.org/10.1097/COH.0b013e32835fc68a
Cory, Theodore ; Schacker, Timothy W. ; Stevenson, Mario ; Fletcher, Courtney V. / Overcoming pharmacologic sanctuaries. In: Current Opinion in HIV and AIDS. 2013 ; Vol. 8, No. 3. pp. 190-195.
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