Treatment modification in human immunodeficiency virus-infected individuals starting combination antiretroviral therapy between 2005 and 2008.

BACKGROUND: Adverse effects of combination antiretroviral therapy (CART) commonly result in treatment modification and poor adherence. METHODS: We investigated predictors of toxicity-related treatment modification during the first year of CART in 1318 antiretroviral-naive human immunodeficiency virus (HIV)-infected individuals from the Swiss HIV Cohort Study who began treatment between January 1, 2005, and June 30, 2008. RESULTS: The total rate of treatment modification was 41.5 (95% confidence interval [CI], 37.6-45.8) per 100 person-years. Of these, switches or discontinuations because of drug toxicity occurred at a rate of 22.4 (95% CI, 19.5-25.6) per 100 person-years. The most frequent toxic effects were gastrointestinal tract intolerance (28.9%), hypersensitivity (18.3%), central nervous system adverse events (17.3%), and hepatic events (11.5%). In the multivariate analysis, combined zidovudine and lamivudine (hazard ratio [HR], 2.71 [95% CI, 1.95-3.83]; P < .001), nevirapine (1.95 [1.01-3.81]; P = .050), comedication for an opportunistic infection (2.24 [1.19-4.21]; P = .01), advanced age (1.21 [1.03-1.40] per 10-year increase; P = .02), female sex (1.68 [1.14-2.48]; P = .009), nonwhite ethnicity (1.71 [1.18-2.47]; P = .005), higher baseline CD4 cell count (1.19 [1.10-1.28] per 100/microL increase; P < .001), and HIV-RNA of more than 5.0 log(10) copies/mL (1.47 [1.10-1.97]; P = .009) were associated with higher rates of treatment modification. Almost 90% of individuals with treatment-limiting toxic effects were switched to a new regimen, and 85% achieved virologic suppression to less than 50 copies/mL at 12 months compared with 87% of those continuing CART (P = .56). CONCLUSIONS: Drug toxicity remains a frequent reason for treatment modification; however, it does not affect treatment success. Close monitoring and management of adverse effects and drug-drug interactions are crucial for the durability of CART.

Síntesi en dissolució i fase sòlida de nous derivats primidínics amb una alta diversitat molecular

En aquest treball s'ha desenvolupat una metodologia eficaç envers la síntesi de diferents derivats pirimidínics amb un alt grau de diversitat molecular. Aquesta metodologia es basa en la S-alquilació selectiva dels 2-tiouracils (2) utilitzats com a material de partida. Aquesta reacció es realitza amb bromur de benzil quan es treballa en dissolució, o bé amb la reïna de Merrifield quan la química és sobre suport sòlid. Seguidament, s'alquila selectivament l'àtom d'oxigen de les benzilsulfanilpirimidinones (3) mitjançant la reacció de Mitsunobu, o bé utilitzant diferents halurs d'alquil en presència d'una base. Amb les 4-alcoxipirimidines (4) es realitzen diverses transformacions químiques, per exemple, addicions de Grignard, reducció i posterior metilació del grup carbonil (quan R2 = CH2COPh), etc. Posteriorment, s'oxida el grup sulfanil a sulfona utilitzant m-CPBA. Finalment es desplaça la funció sulfona amb diversos nucleòfils. Gràcies a aquesta metodologia s'han preparat diferents 2-amino-4-alcoxipirimidines (7, Nu = RR'N) en dissolució i sobre suport sòlid. Mitjançant algunes variacions s'han pogut obtenir altres derivats pirimidínics: - 4(3H)-pirimidinones 2,6-disubstituïdes (8, Nu = RR'N, ArO, RR'R''C), preparades a partir de la hidròlisi del grup alcòxid (OR5) dels compostos (7) en medi àcid. - imidazo[1,2-a]pirimidinones (9 o 10, n = 1) i pirimido[1,2-a]pirimidinones (9 o 10, n = 2). Els compostos (9) s'han obtingut selectivament a través d'una ciclació intramolecular de les pirimidines (7, Nu = aminoalcohols) utilitzant àcid sulfúric. Quan s'han ciclat els compostos (8, Nu = aminoalcohols) mitjançant una reacció de Mitsunobu intramolecular, s'han obtingut els regioisòmers (9) i (10) en diferents proporcions en funció dels grups presents en l'anell. - pirimidines funcionalitzades amb restes d'-arilglina (11). La funció arilglicina s'ha preparat mitjançant la condensació d'amines (4, R2 = CH2CHR3NHR4) amb àcid glioxàlic i àcids arilborònics (reacció de Petasis). L'oxidació del grup sulfanil dels compostos (11) a sulfona utilitzant m-CPBA ha provocat també l'oxidació de l'àtom de nitrogen de l'arilglicina. Alguns d'aquests derivats pirimidínics han mostrat ser inhibidors del Mycobacterium tuberculosis.

Toxicological and histopathological effects of hydramethylnon on Atta sexdens rubropilosa (Hymenoptera: Formicidae) workers

The leaf-cut ants are important agricultural pest, because they can cause intense defoliation in plants and destroy large areas cultivated. Although there are several works for the control of these insects by examining the toxicity of natural chemical compounds on various species of ants, few are focused on analyses of morphological changes caused in the affected organs. The aim of this study was to evaluate the effects of hydramethylnon on Atta sexdens rubropilosa workers through toxicological bioassays and morphological analysis of the post-pharyngeal glands, midgut, and Malpighian tubules of these ants. Hydramethylnon dissolved either in acetone (HA) or in a mixture of acetone and soy oil (HAO) was added to the artificial diet at a concentration of 200 μg/mL. The workers fed daily with the diet containing hydramethylnon showed higher mortality than the controls, especially when HAO was used. Moreover, light and electron microscopy revealed morphological alterations in the midgut and Malpighian tubules of workers treated with HA, whereas alterations of the post-pharyngeal glands were observed in the HAO-treated group. These results indicated that the presence of soy oil provided an alternate route for the ingestion of the formicide's active ingredient and corroborated previous studies that suggested a role for the post-pharyngeal glands in lipid metabolism. Our findings suggest that the oil may carry hydramethylnon to the gland lumen, resulting in lower quantity of the active ingredient in the intestinal lumen and Malpighian tubules that explains the lower degree of morphological alterations in these structures in the workers treated with HAO. These results may provide insight into the toxicological effects of hydramethylnon on leaf-cutting ants and the use of vegetable oil as an adjuvant in baits to control ants. © 2012 Elsevier Ltd.