Antivirals against Herpes Viruses

Aoki, Fred Y.

doi:10.1016/b978-1-4557-4801-3.00045-x

Cited by 9 publications

(14 citation statements)

References 441 publications

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“…Acyclovir’s moderate to severe side effects, including neurotoxicity, may be associated with high serum acyclovir levels (>25 mg/L). Moreover, detectable CMMG levels in CSF are associated with neurotoxicity [ 11 , 23 , 24 , 25 ].…”

Section: Acyclovirmentioning

confidence: 99%

Optimizing Antiviral Dosing for HSV and CMV Treatment in Immunocompromised Patients

et al. 2023

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Herpes simplex virus (HSV) and cytomegalovirus (CMV) are DNA viruses that are common among humans. Severely immunocompromised patients are at increased risk of developing HSV or CMV disease due to a weakened immune system. Antiviral therapy can be challenging because these drugs have a narrow therapeutic window and show significant pharmacokinetic variability. Above that, immunocompromised patients have various comorbidities like impaired renal function and are exposed to polypharmacy. This scoping review discusses the current pharmacokinetic (PK) and pharmacodynamic (PD) knowledge of antiviral drugs for HSV and CMV treatment in immunocompromised patients. HSV and CMV treatment guidelines are discussed, and multiple treatment interventions are proposed: early detection of drug resistance; optimization of dose to target concentration by therapeutic drug monitoring (TDM) of nucleoside analogs; the introduction of new antiviral drugs; alternation between compounds with different toxicity profiles; and combinations of synergistic antiviral drugs. This research will also serve as guidance for future research, which should focus on prospective evaluation of the benefit of each of these interventions in randomized controlled trials.

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Section: Acyclovirmentioning

confidence: 99%

Optimizing Antiviral Dosing for HSV and CMV Treatment in Immunocompromised Patients

et al. 2023

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“…Sixteen percent of patients who were treated died versus 30% of non-treated patients; further, none of the 6 patients with proven HSV pneumonia treated with IV acyclovir 10 mg/kg/dose every 8 h died [ 33 ]. There are no controlled trials for treatment of encephalitis, other visceral infections or disseminated infections caused by HSV, but higher doses of IV acyclovir at 10 mg/kg/dose every 8 h for 2–3 weeks are recommended for such severe HSV infections [ 53 ].…”

Section: Antiviral Drugs and Treatment For Hsv/vzvmentioning

confidence: 99%

“…The most common mechanism of acyclovir resistance in HSV arises from the mutation of viral thymidine kinase, while the mutation of viral DNA polymerase is much less frequent [ 53 ]. Resistance is more common in immunocompromised hosts and is thought to constitute around 4–7% of all HSV isolates in this patient population [ 54 ].…”

Section: Antiviral Drugs and Treatment For Hsv/vzvmentioning

confidence: 99%

“…In cancer patients with localized dermatomal HZ, oral acyclovir at a higher dose (e.g., 800 mg 5 times a day) is an acceptable antiviral agent if patient tolerates oral therapy [ 53 ]. However, valacyclovir should be the preferred agent given its superior bioavailability and less frequent dosing (e.g., 1 g 3 times daily).…”

Section: Antiviral Drugs and Treatment For Hsv/vzvmentioning

confidence: 99%

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Herpes Simplex Virus and Varicella Zoster Virus Infections in Cancer Patients

Tayyar

2023

Viruses

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Herpes simplex virus (HSV) and varicella zoster virus (VZV) are alpha herpesviruses that establish life-long latent infection in neuronal ganglia after primary infection. Periodic reactivation of these viruses results in recurrent infections that can have significant impact on patients’ quality of life. HSV commonly causes oral and genital mucocutaneous infections whereas VZV is responsible for varicella/chickenpox and herpes zoster/shingles, but cancer patients are at particularly higher risk of complications including disseminated and visceral infections due to impaired cell-mediated immunity. While diagnosis of more common HSV and/or VZV infections is frequently clinically based, immunocompromised hosts may have atypical skin presentation or visceral involvement. Thus, diagnostic confirmation using virus-specific tests such as polymerase chain reaction or immunohistochemical staining is crucial in some cases. Oral acyclovir, valacyclovir and famciclovir are usually used for mild to moderate infections and intravenous acyclovir is the drug of choice for severe or disseminated infections. Foscarnet can be used when acyclovir-resistance is confirmed or suspected. Pharmaceutical prophylaxis against HSV and/or VZV should be considered in high-risk cancers patients. Currently, there is no commercially available vaccine against HSV, but VZV vaccines are available to prevent varicella and zoster.

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“…There is an effective vaccine against the virus, and oral antivirals can control the disease. However, the molecular pathogenesis of the disease precludes a definite cure (1,2). The covalently closed circular DNA in-tegrated into the hepatocyte genome cannot be eradicated (2).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Seroprevalence of Viral Hepatitis and the Human Immunodeficiency Virus Among Hospital Workers in Turkey and the Turkish Republic of Northern Cyprus

et al. 2020

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Background:The hepatitis B virus (HBV) is one of the major causes of chronic liver disease. From the perspective of hospital workers (HWs), employees are at risk of hepatitis B infection because of occupational exposure. Apart from this occupational risk, health professionals may still be affected by HBV, depending on the epidemiological characteristics of the country and geographical region they live in.Objectives: This study aimed to determine HBV, HCV, and HIV seroprevalence among HWs using data obtained from 21 hospitals located in six geographical regions in Turkey and the Turkish Republic of Northern Cyprus. Methods: The study was designed as a retrospective, multicentre, descriptive study. Twenty hospitals from Turkey and one hospital from the Turkish Republic of Northern Cyprus were involved in the study. The variables of the study were vaccination status against HBV and hepatitis A and HBsAg, anti-HBs, anti-HBcIgG, anti-HAV IgG, anti-HCV, anti-HDV, and anti-HIV serology results belonging to the previous year.Results: Women constituted 58.9% (n = 5,622) of the HWs included in the study. The mean age was 36.3 ± 9.09 years (min = 18, max = 72). In terms of occupation, 42.5% (n = 4,064) were nurses/health officers, and 24.8% (n = 2365) were physicians. HBsAg seroprevalence was found to be 1.8% (n = 169; 95% CI = 1.5% -2.0%), while anti-HBs seropositivity was 75.7% (n = 7,234). About 7.3% (n = 701) had natural immunity to hepatitis B. About 21.6% (n = 2,066) of the HWs did not receive hepatitis B vaccine. Conclusions: This study is the first study involving a large sample size from different locations of Turkey. According to the results, hepatitis B and hepatitis A vaccines should be administered to susceptible individuals and HWs.

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Antivirals against Herpes Viruses

Cited by 9 publications

References 441 publications

Optimizing Antiviral Dosing for HSV and CMV Treatment in Immunocompromised Patients

Optimizing Antiviral Dosing for HSV and CMV Treatment in Immunocompromised Patients

Herpes Simplex Virus and Varicella Zoster Virus Infections in Cancer Patients

Evaluation of the Seroprevalence of Viral Hepatitis and the Human Immunodeficiency Virus Among Hospital Workers in Turkey and the Turkish Republic of Northern Cyprus

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