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Introduction
  • Drugs
    • HIV anti-viral medications or highly active antiretroviral therapy (HAART)
      • nucleoside analog reverse transcriptase inhibitors (NRTI)
      • non-nucleoside reverse transcriptase inhibitors (NNRTI)
      • fusion inhibitors
      • integrase inhibitors
      • protease inhibitors
    • HCV anti-viral medications
    • other anti-viral medications
  • Clinical use
    • viral infections 
      • for HIV infections, regimen often consists of 3 drugs to prevent resistance: 2 NRTIs and an integrase inhibitor
        • increasingly regimens are tailored to viral genomics and resistance patterns
      • for HCV infections, regimen also consists of multiple drugs to prevent resistance
 
HIV Highly Active Antiretroviral Therapy (HAART)
Drugs Mechanism of Action
High Yield Adverse Effects

Abacavir (ABC)
Didanosine (DDL)
Emtricitabine
Lamivudine
Stavudine
Zidovudine (ZDV)
Tenofovir (a nucleotide rather than nucleoside)

  • NRTI
  • Bone marrow suppression
  • Peripheral neuropathy
  • Lactic acidosis
  • Anemia (ZDV)
  • Pancreatitis (DDL)
  • Drug hypersensitivity (ABC) (HLA-B*5701 positive patients)
  • ZDV can be used during pregnancy
Delavirdine
Efavirenz
Nevirapine
  • NNRTIs
  • Drug rash
  • Liver toxicity
  • Vivid dreams (efavirenz)
  • Neurologic symptoms (efavirenz)
  • Contraindicated in pregnancy (efavirenz, delavirdine)
Atazanavir
Darunavir
Fosamprenavir
Indinavir
Lopinavir
Ritonavir
Saquinavir
  • Protease inhibitors, preventing maturation of new viruses
  • Hyperglycemia
  • Gastrointestinal upset
  • Cushing-like syndrome
  • Renal toxicity (indinavir)
  • Thrombocytopenia (indinavir)
  • Inhibits cytochrome P450 (ritonavir)

Dolutegravir
Elvitegravir
Raltegravir

  • Integrase inhibitors, inhibiting integration of viral genome into host cell chromosome
  • Increased serum creatine kinase
Enfuvirtide
Maraviroc
  • Fusion inhibitors
  • Enfuvirtide: inhibits viral entry by binding to viral gp41
  • Maraviroc: inhibits viral entry by binding CCR-5 on host T-cells, inhibiting its interaction with viral gp120
  • Injection site reactions (enfuvirtide)
  • Peripheral neuropathy (enfuvirtide)
  • Hepatotoxicity (maraviroc)
Griseofulvin
  • Disrupts mitosis via microtubule dysfunction
  • Especially targets keratin-containing tissues such as nails
  • Fungistatic
  • Teratogenic
  • Disulfiram-like reaction
  • Neurologic symptoms
    • confusion
    • headaches
  • Induces cytochrome P450
 
HCV Anti-Viral Medications
Drug Mechanism of Action
High Yield Adverse Effects
Indications
Ribavirin
  • Guanine nucleotide synthesis inhibition
  • Hemolytic anemia
  • Teratogenic
  • RSV
  • HCV
Interferons
  • Glycoprotein analogs (normally synthesized by infected cells, as well as tumor cells)
  • Flu-like symptoms
  • Neutropenia
  • Myopathy
  • Depression
  • HBV
  • HCV
  • Kaposi sarcoma
  • Condyloma acuminatum
Ledipasvir
  • Viral phosphoprotein (NS5A) inhibitor, which disrupts viral replication
  • Fatigue
  • Headache
  • HCV
Simeprevir
  • HCV protease (NS3/4A) inhibitor, disrupting replication
  • Photosensitivity
  • Pruritus
  • Fatigue
  • Headache
  • HCV
Sofosbuvir 
  • HCV RNA-dependent RNA polymerase (NS5B) inhibitor
  • Fatigue
  • Headache
  • Nausea
  • HCV
Other Anti-Viral Medications

Oseltamivir
Zanamivir

  • Inhibits neuraminidase, which results in decrease of progeny viruses
  • Gastrointestinal upset
  • Influenza A and B

Acyclovir
Famciclovir
Valacyclovir

  • Guanosine analogs and inhibits viral DNA polymerase
  • Specifically processed by HSV/VZV enzymes
  • Obstructive crystalline nephropathy which can lead to acute renal failure
    • hydration can prevent this
  • HSV
  • VZV

Ganciclovir
Valganciclovir

  • Guanosine analogs and inhibits viral DNA polymerase
  • Specifically processed by CMV viral enzymes
  • Bone marrow suppression
  • Renal toxicity
  • CMV
Foscarnet
  • Viral DNA and RNA polymerase inhibitor
  • HIV reverse transcriptase inhibitor
  • Renal toxicity
  • Seizures secondary to electrolyte abnormalities
  • Acyclovir-resistant HSV
  • Ganciclovir-resistant CMV
Cidofovir
  • Viral DNA polymerase inhibitor
  • Renal toxicity
    • coadminister with probenecid and hydration
  • CMV retinitis
  • Acyclovir-resistant HSV
 

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