Chapter 108 : Antiviral Agents

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The use of antiviral agents for the treatment of viral diseases continues to expand. Most of the agents currently approved by the Food and Drug Administration (FDA) are active against one or more of the following viruses: human immunodeficiency virus types 1 and 2 (HIV-1 and HIV-2), hepatitis B and C viruses (HBV and HCV, respectively), the human herpesviruses, and influenza A and B viruses. This chapter is organized according to these virus groups, with cross-referencing for agents with activity against more than one group of viruses. There are now five classes of antiviral agents for treatment of HIV-1: (i) nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs and NtRTIs), (ii) nonnucleoside reverse transcriptase inhibitors (NNRTIs), (iii) protease inhibitors (PIs), (iv) entry/fusion inhibitors, and (v) integrase strand transfer inhibitors (INSTIs). The only antiviral agents that have shown any activity in achieving a sustained virologic response against chronic HCV infection are standard interferon (IFN)-α; 2a and 2b, pegylated IFN-α; (PEG-IFN) 2aµ and 2b, and combinations of these IFNs with ribavirin (RBV). There are two major classes of drugs available to treat HBV: nucleoside and nucleotide analogues and IFNs. Most of the antiviral compounds that are approved to treat the eight human herpesviruses are nucleoside or nucleotide analogues which inhibit DNA replication. The two classes of antiviral agents for the treatment of influenza are M2 protein inhibitors (active only against type A influenza viruses) and neuraminidase inhibitors (activity against both type A and B viruses).

Citation: Lurain N, Thompson K. 2011. Antiviral Agents, p 1687-1709. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch108
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Antiviral agents for HIV therapy

Pharmaceutical companies: Abbott Laboratories, North Chicago, IL; BI, Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT; BMS, Bristol-Myers Squibb, Princeton, NJ; Gilead Sciences, Foster City, CA; GSK, GlaxoSmithKline, Research Triangle Park, NC; Merck & Co., Whitehouse Station, NJ; Pfizer, New York, NY; Roche Pharmaceuticals, Nutley, NJ; Tibotec Therapeutics, Division of Ortho Biotech Products, L.P., Raritan, NJ.

Gastrointestinal (GI) symptoms include nausea, vomiting, and diarrhea.

Citation: Lurain N, Thompson K. 2011. Antiviral Agents, p 1687-1709. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch108
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Antiviral agents for HCV therapy

Pharmaceutical companies: Roche Pharmaceuticals, Nutley, NJ; S-P, Schering-Plough, Kenilworth, NJ.

Gastrointestinal (GI) symptoms include nausea, vomiting, and diarrhea.

Citation: Lurain N, Thompson K. 2011. Antiviral Agents, p 1687-1709. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch108
Generic image for table

Antiviral agents for HBV therapy

Pharmaceutical companies: BMS, Bristol-Myers Squibb, Princeton, NJ; Gilead Sciences, Foster City, CA; Novartis Pharmaceuticals Corporation, East Hanover, NJ.

Citation: Lurain N, Thompson K. 2011. Antiviral Agents, p 1687-1709. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch108
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Antiviral agents for herpesviruses

Pharmaceutical companies: AstraZeneca, Wilmington, DE; BMS, Gilead Sciences, Foster City, CA; GSK, GlaxoSmithKline, Research Triangle Park, NC; Monarch Pharmaceutical, Bristol, TN; Novartis, East Hanover, NJ; Roche Pharmaceuticals, Nutley, NJ.

Gastrointestinal (GI) symptoms include nausea, vomiting, and diarrhea.

Valacyclovir is used in some transplant settings for HCMV prophylaxis.

Cidofovir also has reported activity against human papillomavirus, polyomavirus, adenovirus, and poxvirus.

Ganciclovir and valganciclovir also have in vitro activity against EBV, HHV-6, HHV-7, and HHV-8.

Penciclovir is used to treat herpes labialis but also has activity against HSV-2 and VZV.

Vidarabine has in vitro activity against vaccinia virus and VZV.

Trifluridine is used to treat herpes keratitis but also has activity against HSV-2 and VZV.

Citation: Lurain N, Thompson K. 2011. Antiviral Agents, p 1687-1709. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch108
Generic image for table

Antiviral agents for influenza viruses

Pharmaceutical companies: Endo Pharmaceuticals Inc., Chadds Ford, PA; Forrest Laboratories, Inc., St. Louis, MO; Roche Laboratories Inc., Nutley, NJ (licensor, Gilead Sciences, Inc., Foster City, CA); GSK, GlaxoSmithKline, Research Triangle Park, NC.

CNS symptoms include confusion, anxiety, insomnia, difficulty concentrating, dizziness, hallucinations, and seizures; gastrointestinal (GI) symptoms include nausea, vomiting, and anorexia; neuropsychiatric symptoms include self-injury and delirium.

Citation: Lurain N, Thompson K. 2011. Antiviral Agents, p 1687-1709. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch108

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