Antiviral Drugs for Viruses Other Than Human Immunodeficiency Virus

October 2011
Mayo Clinic Proceedings;Oct2011, Vol. 86 Issue 10, p1009
Academic Journal
Most viral diseases, with the exception of those caused by human immunodeficiency virus, are seifilmited ilinesses that do not require specific antivirai therapy. The currentiy avaiiabie antivirai drugs target 3 main groups of viruses: herpes, hepatitis, and influenza viruses. With the exception of the antisense molecule fomivirsen, au antiherpes drugs inhibit virai repiicatlon by serving as competitive substrates for viral DNA polymerase. Drugs for the treatment of influenza inhibit the ion channel M2 protein or the enzyme neuraminidase. Combination therapy with interferonu and ribavirin remains the backbone treatment for chronic hepatitis C; the addition of serine protease inhibitors improves the treatment outcome of patients infected with hepatitis C virus genotype 1. Chronic hepatitis B can be treated with interferon or a combina- tion of nucieos(t)ide analogues. Notably, almost all the nucleos(t) ide anaiogues for the treatment of chronic hepatitis B possess antihuman immunodeficiency virus properties, and they inhibit replication of hepatitis B virus by serving as competitive substrates for its DNA polymerase. Some antivirai drugs possess multipie potential clinical applications, such as ribavirin for the treatment of chronic hepatitis C and respiratory syncytial virus and cidofovir for the treatment of cytomegaiovirus and other DNA viruses. Drug resistance is an emerging threat to the clinical utility of antiviral drugs. The major mechanisms for drug resistance are mutations in the virai DNA poiymerase gene or in genes that encode for the viral kinases required for the activation of certain drugs such as acyciovir and ganclclovlr. Widespread antiviral resistance has urnited the clinical utility of M2 inhibitors for the prevention and treatment of influenza infections. This article provides an overview of clinicaily avaliable antivirai drugs for the primary care physician, with a speciai focus on pharmacoiogy, clinical uses, and adverse effects.


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