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Chapter 14 : Antiviral Therapies

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Antiviral Therapies, Page 1 of 2

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Abstract:

A brief historic account of anti-HIV therapies is provided in this chapter, followed by an update on present treatment approaches. The current antiviral drugs, when used in combination, now considered a cocktail of highly active antiretroviral therapy (HAART), have shown promise in controlling HIV infection. Nevertheless, the need for adherence to treatment and the toxic effects of certain drugs are noteworthy and encourage further studies to improve anti-HIV strategies. Some infected individuals and some clinicians are reluctant to begin early therapy for HIV infection because they fear that resistance will emerge and no further antiviral drugs will be available. Soon after the introduction of HAART, several studies indicated that despite the absence of detectable circulating HIV, reservoirs of infected CD4 cells could remain in the infected individual for 4 to 60 years. Importantly, drug resistance appears to be less prevalent in areas in which adherence to therapy is emphasized. While current antiviral drugs have had substantial beneficial effects on HIV infection and development of disease, the side effects can be very harmful to the infected individual. Immune-based therapies may help with HAART to restore immune cell numbers and some function, the full restoration of the immune system should be an important objective. As HAART can reduce both humoral and cellular immune responses to HIV, approaches have been initiated to maintain or enhance anti-HIV responses during therapy. Information on many different drugs showing anti-HIV activity in vitro appears regularly in the literature, but their clinical efficacy awaits further evaluation.

Citation: Levy J. 2007. Antiviral Therapies, p 363-396. In HIV and the Pathogenesis of AIDS, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815653.ch14

Key Concept Ranking

MHC Class II
0.4399318
Tumor Necrosis Factor alpha
0.43083686
Highly Active Antiretroviral Therapy
0.4038719
0.4399318
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Figures

Image of Figure 14.1
Figure 14.1

Schematic representation of the early development of anti-HIV drugs over time. At the left side are the nucleoside analogues. At the right side are the nonnucleoside drugs. The tree presents several different approaches directed at the replicative cycle of HIV. Modified from reference 3963 with kind permission of Springer Science and Business Media and provided by R. Schinazi.

Citation: Levy J. 2007. Antiviral Therapies, p 363-396. In HIV and the Pathogenesis of AIDS, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815653.ch14
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Image of Figure 14.2
Figure 14.2

(A) Doughnut-shaped HIV-1 particles from a T-cell line infected with a protease-deficient virus (2078). The morphology of the particles resembles that of viruses released from protease inhibitor-treated cells. (B) For comparison, the wild-type virus released from the T-cell line is presented. Bar, 100 nm. Figure provided by K. Ikuta.

Citation: Levy J. 2007. Antiviral Therapies, p 363-396. In HIV and the Pathogenesis of AIDS, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815653.ch14
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Image of Figure 14.3
Figure 14.3

Therapeutic approaches for controlling HIV infection. (A) In untreated infected individuals who remain asymptomatic and have normal CD4 cell counts, control of HIV replication in infected CD4 cells appears to be mediated by CD8 cells, particularly noncytotoxic cells that release the CD8 antiviral factor (CAF). (B) When this cell-mediated immune response decreases (secondary to a variety of factors suggested in the text), HIV is produced. Present combination therapy prevents this released virus from reinfecting fresh cells and can restore CD4 cell levels. The viral load is reduced. However, resistant strains can emerge if this arrest in virus replication is not complete. (C) The optimal control of HIV infection would come from a dual approach in which immune modulators are used to enhance the CD8 cell antiviral response and antiretroviral drugs are administered to prevent infection of fresh cells by the free virus remaining in the host.

Citation: Levy J. 2007. Antiviral Therapies, p 363-396. In HIV and the Pathogenesis of AIDS, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815653.ch14
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References

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Tables

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Table 14.1

Potential approaches to therapies for HIV infection

Citation: Levy J. 2007. Antiviral Therapies, p 363-396. In HIV and the Pathogenesis of AIDS, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815653.ch14
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Table 14.2

Drugs approved for the treatment of HIV infection

Citation: Levy J. 2007. Antiviral Therapies, p 363-396. In HIV and the Pathogenesis of AIDS, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815653.ch14
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Table 14.3

CD4 cell and virus level considerations for initiating antiretroviral therapy, 2003

Citation: Levy J. 2007. Antiviral Therapies, p 363-396. In HIV and the Pathogenesis of AIDS, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815653.ch14
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Table 14.4

Common side effects of antiretroviral therapy

Citation: Levy J. 2007. Antiviral Therapies, p 363-396. In HIV and the Pathogenesis of AIDS, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815653.ch14
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Table 14.5

Effects of antiretroviral therapy on the immune system

Citation: Levy J. 2007. Antiviral Therapies, p 363-396. In HIV and the Pathogenesis of AIDS, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815653.ch14
Generic image for table
Table 14.6

Potential immune-based therapies for HIV infection

Citation: Levy J. 2007. Antiviral Therapies, p 363-396. In HIV and the Pathogenesis of AIDS, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815653.ch14
Generic image for table
Table 14.7

Biologic and molecular features of HIV that affect antiviral therapy

Citation: Levy J. 2007. Antiviral Therapies, p 363-396. In HIV and the Pathogenesis of AIDS, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815653.ch14

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