Abstract

Background

The intracellular and plasma concentrations of HIV protease inhibitors (HPIs) vary widely in vivo. It is unclear whether there is a concentration-dependent effect of HPIs such that at increasing concentration they may either block their own efflux (leading to ‘autoboosting’) or influx (leading to saturability/decreased intracellular accumulation).

Method

The effects of various concentrations (0–30 µM) of lopinavir, saquinavir, ritonavir and atazanavir on the accumulation of [14C]lopinavir, [3H]saquinavir, [3H]ritonavir and [3H]atazanavir, respectively, were investigated in CEMparental, CEMVBL [P-glycoprotein (ABCB1) overexpressing], CEME1000 (MRP1 overexpressing) and in peripheral blood mononuclear cells (PBMCs). We also investigated the effects of inhibitors of ABCB1/ABCG2 (tariquidar), ABCC (MK571) and ABCC1/2 (frusemide), singly and in combination with HPIs, on cellular accumulation.

Results

In all the cell lines, with increasing concentration of lopinavir, saquinavir and ritonavir, there was a significant increase in the cellular accumulation of [14C]lopinavir, [3H]saquinavir and [3H]ritonavir. Tariquidar, MK571 and frusemide (alone and in combination with lopinavir, saquinavir and ritonavir) significantly increased the accumulation of [14C]lopinavir, [3H]saquinavir and [3H]ritonavir. Ritonavir (alone or in combination with tariquidar) decreased the intracellular accumulation of [3H]ritonavir in PBMCs. Atazanavir decreased the accumulation of [3H]atazanavir in a concentration-dependent manner in all of the cells tested.

Conclusions

There are complex and variable drug-specific rather than class-specific effects of the HPIs on their own accumulation.

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