Zidovudine

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  • only drug shown to reduce mortality in late-stage AIDS, reduce opportunistic infection and progression to AIDS

Mechanism of Action

  • ZDV enters cell by diffusion undergoes anabolic phosphorylation to the triphosphate ZDV-TP
  • This is a competitive inhibitor of HIV-1 RT, therefore when incorporated causes chain termination as incoming nucleotide triphosphate cannot make a triphosphate bond
  • Human DNA polymerases are much less sensitive to inhibition therefore selective viral effect

Adverse Effects

  • Bone marrow suppression causing anaemia
  • Nausea+ vomiting
  • Fatigue/headache
  • Melanonychia (blue-grey nail discolouration)
  • Mitochondrial myopathy (rare)
  • Mutagenic and carcinogenic (used in pregnant women as reduces HIV maternal-foetal transmission)

Pharmacokinetics

  • Almost totally absorbed from gut >90% (Orally, 200mg 3X daily)
  • Short half life 1-2hrs
  • Resistance develops slowly
  • Several drug interactions
 

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