Antiviral Agents, Vaccines, and Immunotherapies PDF

Preface

The development of antiviral drugs is still in its infancy with rapid changes and progressive milestones encountered almost daily. By the time this book is distributed, new drugs may have already been added. This is particularly true for the antiretroviral drugs, which seem to be growing in number exponentially to the casual observer trying to keep abreast of recent advances in this field. As this book is going to press, the United States Food and Drug Administration granted accelerated approval of Epzicom and Truvada. Epzicom is a fixeddose combination of the antiretroviral drugs Ziagen (abacavir sulfate) and Epivir Oamivudine). Truvada is a fixed-dose combination of Emtriva (embricitabine) and Viread (tenofovir disoproxil fumarate). In keeping pace with these advances, the book will survey the latest in antiretroviral drugs, general antiviral therapies, the antiviral vaccines, and immunotherapies used for treatment, and prophylaxis of viral infections.

The book begins with a review ofthe current state of antiviral management (therapy and prophylaxis) and discussion of the challenges for the future. The second chapter discusses the major categories as well as the indications, adverse reactions, and drug interactions of each specific medication of the antiretroviral drugs. Chapter Three delves into the treatments available for other viral infections, such as herpes simplex virus, varicella zoster virus, cytomegalovirus, human papilloma virus, chronic viral hepatitis, and others. The book then concludes with a discussion of the vaccines that are currently available and being developed and gives an overview of the use of immunoglobulins and monoclonal antibodies for antiviral therapy.

The last two decades have been the most dynamic in the history of viral infections and their management. During this time the eradication of the epidemic form of the most deadly viral infection known to medicine, smallpox, was announced. Ironically, this landmark achievement was followed almost immediately by the observation of a new viral pandemic that currently infects 46 million people, i.e., HIV/AIDS. Within the past decade several new emerging viral diseases, e.g., West Nile virus, SARS, avian influenza, etc., have challenged our ability to recognize and manage these infections. Unfortunately, antiviral drugs have been effective for only a few groups of viruses up until now. Most antiviral drugs do not produce a cure, but rather allow control of the infection. An exception to this observation has recently been seen with the combined use of pegylated interferon alpha and ribavirin, which allows virologic cures for the majority of hepatitis C patients who successfully complete therapy. However, the limitations of antiviral therapy, including the high costs of drugs, make the need for prevention even more urgent. The most cost effective means of prevention are public health measures, such as proper sanitation/clean drinking water, mosquito control, testing blood/blood products, not sharing needles, and safer sex/condom use. In addition, vaccines provide the most effective and cost-efficient means of preventing infectious diseases. The greatest success story in medical history was' the eradication of epidemic smallpox, which was due to a combined effort of public health measures and an effective vaccine. For such combined efforts to eradicate other viral diseases, such as measles and polio, the challenges are not only to reach the susceptible populations but also to overcome unfounded prejudice against vaccines. At the same time, new technologies will lead to the development of new prophylactic vaccines, particularly for infections such as HIV, human papillomaviruses, and herpes simplex viruses, ushering in a whole new set of arsenals in the fight against viral infections. It is my hope that Antiviral Agents, Vaccines, and Immunotherapies will serve as a valuable tool for the clinician and the basic scientist in better understanding the current management protocols ofviral diseases as well as greater possibilities for the future.