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Antiviral tx strategies
Stop immunosuppression, IVIg (good for parvovirus, CMV, rabies), and antivirals.
Viral replication
Attaches and goes into vesicle where is disassembles. The genome is exposed and goes to nucleus (DNA) or cytoplasm (RNA) where it is duplicated.

Then protein virion goes to membrane and gets out and infects other cells.
Target and activity of nucleoside and NT analogs
DNA replication; herpes, HBV, HCV and HIV
Target and activity of Neuraminidase inhibitors
release of virions; influenza
Target and activity of interferon alpha
immune response; HBV and HCV
Acyclovir - MOAction
Nucleoside analog

Against wide range of herpes viruses.

Analog of guanosine that needs thymidine kinase to activate it (present in herpes viruses except CMV). Then it inhibits herpes DNA polym because the phopsphorylated acyclovir incorps into the DNA chain and terminates it.
pharmacokin of acyclovir
oral and IV but poorly absorpbed orally.

so if a serious ifnection, need the IV form.
Ganciclovir
Nucleoside analog

Good against CMV as well because it doesnt need virus-provided thymidine kinase for activation.

Resistance is a big issue with this one.
Spectrum of acyclovir and gancyclovir
Acyclovir - HSV1, 2, varicella zoster.

Gancyclovir - HSV1, 2, varicella zoster, CMV.
Tx of influenza (prophylaxis and tx)
M2 inhibitors (amantadine and rimantadine) - Good for A only

or neuraminidase inhibitors (Zamamivir or oseltamivir) - For A and B
M2 channel inhibitors
Amantadine and rimantadine

prevent uncoating and release of genome of the viruses.
Neuraminidase inhibitors
Zamamivir and oseltamivir

Prevent release of the virus from the membrane into the extracellular env (by inhibiting neuraminidase - the enzyme that allows this...)
Viruses causing hepatitis than can be helped with antivirals
Hep B, C and CMV
Hep B
Much higher risk of hepatocellular CA. If it gets infants, more risk of being a chronic carrier.

Use pegylated interferon (long acting and high blood levels) or oral drugs (analogs)
HBV replication
complex. Can be normal classic dogma or reverse txpn
Interferon for Hep b
subcut. Very toxic but no resistrance.
analogs of Hep B
nucleoside - lamivudine, entecavir, telbivudine

NT - adefovir and tenofovir

oral, well tolerated but there is both resistance and cross-resistance.
endpoints to monitor for HBV success of therapy
HBeAg loss and seroconversion to HBeAb positive

HBsAg loss and HBsAb seroconversion (this is pretty rare)

Less HBV viral load (DNA)

Histological improvement.
Signs of good px of HBV treatment
less DNA, ALT normalization, improvement in histology, HBeAg-->HBeAb and HBsAg-->HBsAb
Tx of chronic hep C
pegylated alpha interferon and ribavirin (which is a guanosine analog that inhibits viral RNA binding to ribosomes)

use both of these together (in contrast to tx of HBV)
signs of good px in tx of HCV
drop in HCV viral load, normalization of LFTs, better histology