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)EmtricitabineLamivudineStavudineZidovudine (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 DelavirdineEfavirenzNevirapine NNRTIs Drug rash Liver toxicity Vivid dreams (efavirenz) Neurologic symptoms (efavirenz) Contraindicated in pregnancy (efavirenz, delavirdine) AtazanavirDarunavirFosamprenavirIndinavirLopinavirRitonavirSaquinavir Protease inhibitors, preventing maturation of new viruses Hyperglycemia Gastrointestinal upset Cushing-like syndrome Renal toxicity (indinavir) Thrombocytopenia (indinavir) Inhibits cytochrome P450 (ritonavir) DolutegravirElvitegravirRaltegravir Integrase inhibitors, inhibiting integration of viral genome into host cell chromosome Increased serum creatine kinase EnfuvirtideMaraviroc 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 OseltamivirZanamivir Inhibits neuraminidase, which results in decrease of progeny viruses Gastrointestinal upset Influenza A and B AcyclovirFamciclovirValacyclovir 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 GanciclovirValganciclovir 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