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Chapter 10 An Evolving Enemy • Silvio Penta • Christie DiDonato • Carl Tuoni • Beth Miller Question • What is AZT and how does it stop HIV from reproducing and causing AIDS? In the early 1990s researchers began to find AZT -resistant strains of HIV in recently infected patients who have never been treated with AZT. How can this be? Explain Background • Azidothymidine, or AZT, was the first antiretroviral drug approved for treatment of HIV. First synthesized in 1964 by the US National Institute of Health for treatment of cancer. It was found ineffective on cancer infected lab rats and was shelved. In 1985 it was reexamined as an AIDS treatment and was found to prolong the life of AIDs infected patients. http://www.niaid.nih.gov/publications/hiv aids/23.htm http://www.chrisdellavedova.com/wpcontent/uploads/2007/10/scientist.gif What is AZT? • AZT is the foundation stone • • • • AZT works by interfering of the AIDS drug with cell division. construction. • DNA is a chain of molecular beads (nucleotides) one It was the first drug being Thymidine, of which approved for the treatment AZT is a defective analog. of AIDS and the HIV This can be threaded on the infection in 1987. chain, but stops further It is usually used in two or growth through the addition three drug “cocktails”, of natural nucleotides. rather than alone. • This mechanism stops the HIV from inserting itself into It is also the main drug human DNA. used to prevent HIV transmission from mother to www.3dchem.com child. AZT • AZT is one of the nucleoside reverse transcriptase inhibitors (NRTIs). These drugs work by disrupting an HIV protein or enzyme called reverse transcriptase, which is involved in the production of new viruses. These drugs block the reverse transcriptase enzyme. www.aidsinfonet.org/factsheet_det ail.php?fsnumber=411 AZT continued… • AZT does not destroy the • HIV infection, but only delays the progression of the disease and the replication of the virus, even at high doses. During prolonged AZT treatment, HIV has the ability to gain an increased resistance by mutation of the reverse transcriptase. www.aras.ab/articles AZT resistant strains in untreated patients? • Mutations that result in drug-resistant variants • can occur both prior to the administration of antiviral drugs as well as during therapy. HIV is notorious for its’ ability to develop drug resistance in patients taking antivirals. Resistance in AZT is peculiar in that multiple amino acid changes and mutations build up over time, yielding a number of virus variants with a high-level drug resistance. AZT resistance • HIV does not make perfect copies of itself. With billions • of viruses being made every day, lots of small, random differences like mistakes can happen. The differences are called mutations. Mutations that change the parts of the virus the drugs are meant to stop can keep the drugs from working. When the drug no longer works against HIV, it is called drug resistance. The virus with the mutation is resistant to the drug. www.atdn .org/simple/resistance.html • When AZT resistant strains of • • HIV are produced they keep multiplying while the non AZT resistant strains are killed off. Eventually there are only AZT resistant strains of HIV left in the body. This strain of HIV will then spread like the normal virus. Drug-resistant viruses may be transmitted in primary infection via sexual or intravenous routes. Side Effects of AZT • AZT has a dark side. Although the immediate results of • • the treatment in AIDS patients may be positive, over time they produce the same symptoms of AIDS itself! There are numerous debilitating or even fatal side effects. Severe anemia that without transfusions could be deadly. Damage to the blood, bone marrow, nerves and muscle is believed to arise from effects on the mitochondria, regulating organelles in every cell. http://aliveandwell The Links: http://www.abc.net.au/rn/talks/8.30/helthrpt/stories/s11490.htm http://www.aids.org/atn/a-191-06.html http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=10220348 5.html May There Be a Cure