29 - Antiviral drugs

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This chapter presents an overview of some antiviral drugs. Topical cidofovir 1–3% has been successfully used for the treatment of oral warts in three HIV-positive patients with no adverse effects. However, ulceration and pain at the site of the lesion, leaving the normal skin unharmed, were reported as the main adverse effect after topical application to high-grade vulval intraepithelial neoplasia in 12 women. Entecavir recently received FDA approval in the United States for use in treatment-naïve hepatitis B e antigen (HBeAg) positive patients and those with evidence of lamivudine resistance. There were no significant differences in adverse events compared with lamivudine. Most of the adverse events were mild or moderate. Lamivudine is being increasingly used in chronic hepatitis B infection. However, resistance arises rapidly with monotherapy and lamivudine is not superior to interferon. The mechanism of the beneficial effect of adding ribavirin to interferon is not fully understood. Ribavirin monotherapy is not effective in hepatitis C. However, adding ribavirin to interferon increases the number of patients with a virological response although it also increases the number of adverse events.

Section snippets

Skin

Topical cidofovir 1–3% has been successfully used for the treatment of oral warts in three HIV-positive patients with no adverse effects (1A). However, ulceration and pain at the site of the lesion, leaving the normal skin unharmed, were reported as the main adverse effect after topical application to high-grade vulval intraepithelial neoplasia in 12 women (2A).

Topical cidofovir 1% has also been used in the successful treatment of a refractory verruca in a child with acute lymphoblastic

Nervous system

It has been suggested that hemodialysis can be a useful diagnostic tool in the differential diagnosis between aciclovir-induced neurotoxicity and herpes encephalitis, as well as a fast and reliable treatment of drug-induced neurotoxicity (6A).

  • A previously healthy 59-year-old woman developed right eye pain for 3 days and vesicle formation on her forehead. She received intravenous aciclovir 250 mg every 8 hours, but 48 hours later she became drowsy and lethargic, with incoherent speech and

Observational studies

A total of 49 consecutive lamivudine-resistant hepatitis B e antigen-negative chronic hepatitis B patients were enrolled in a study of the effects of adefovir 10 mg/day plus lamivudine 100 mg/day (8C). After 52 weeks all had some hepatitis B virus DNA response and 57% had a complete virological response. There was a biochemical response in 76%. There were no serious adverse events.

Entecavir

Entecavir recently received FDA approval in the USA for use in treatment-naïve hepatitis B e antigen (HBeAg) positive

Pleconaril

In a placebo-controlled study of pleconaril in 827 patients with positive baseline nasal mucus cultures for rhinoviruses, those who were infected with viruses that are more highly susceptible to pleconaril (50% effective concentration <0.38 μg/ml) had a median 1.9–3.9 day reduction in symptom duration compared with placebo (65C). In contrast, subjects whose baseline virus isolate susceptibility was >0.38 μg/ml did not benefit from pleconaril. Adverse effects were not mentioned.

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