Antiviral drugs

This review of the 2010 publications on antiviral drugs covers drugs active against cytomegalovirus, herpesviruses, hepatitis viruses, the human immunodeficiency virus (nucleoside analogue reverse transcriptase inhibitors, nucleotide analogue reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, inhibitors of HIV fusion, integrase inhibitors, and chemokine receptor CCR5 antagonists), and influenza viruses (neuraminidase inhibitors and ion channel inhibitors). Cidofovir-associated nephrotoxicity is associated with ultrastructural abnormalities in the proximal tubular mitochondria. Cotard's syndrome, in which patients have a delusion of being dead, has been reported with valaciclovir and aciclovir. Entecavir should be used with caution in cirrhosis, as it may cause lactic acidosis. With the persistent burden of HIV in developing countries, there is an increased amount of high-quality evidence-based research into the safety (and efficacy) of different antiviral drugs and HAART combination regimens in resource-poor settings, advancing our ability to optimize antiretroviral pharmacotherapy there. The prevalence of combination therapy with antiviral drugs also heightens the need for documentation of all suspected drug interactions involving this group. As a class of medications, the antiviral drugs are particularly important to certain vulnerable populations, often comprising immunosuppressed patients, such as those with retroviral disease, transplant recipients, patients with cancers, and children/neonates. The absolute numbers of such patients in studies is often small, emphasizing the importance of rigorous post-marketing surveillance. For the purposes of pharmacovigilance and advancing etiological understanding of rare adverse reactions to antiviral drugs, the development of international case registries and clinical research networks is justified. There is further evidence on lipodystrophy from the use of nucleoside analogue reverse transcriptase inhibitors. Most studies have shown an association between abacavir and myocardial infarction. Etravirine has a similar adverse reactions profile to nevirapine, but the reactions are less intense. Darunavir has an adverse reactions profile similar to other protease inhibitors, whereas tiprinavir is associated with an increased risk of intracranial hemorrhage. Adverse reactions to raltegravir, the first in its class, are increased aminotransferase activities and depression. The tumorigenicity of maraviroc has been debunked in further studies. Maraviroc should be used with caution in other CYP3A4 inhibitors, and its absorption is reduced by 50% when taken with food. Post-marketing surveillance of oseltamivir has shown that it can cause nausea and vomiting and neuropsychiatric effects, and more cases of self poisoning have been reported. Concomitant dosing with probenecid allows the dose of oseltamivir to be reduced. Corneal edema attributable to amantadine continues to be reported, but there is still a debate about whether it arises de novo or as a result of worsening of pre-existing PEX keratopathy.