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      Drug Discovery of Nucleos(t)ide Antiviral Agents: Dedicated to Prof. Dr. Erik De Clercq on Occasion of His 80th Birthday

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          Abstract

          Nucleoside and nucleotide analogues are essential antivirals in the treatment of infectious diseases such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), herpes simplex virus (HSV), varicella-zoster virus (VZV), and human cytomegalovirus (HCMV). To celebrate the 80th birthday of Prof. Dr. Erik De Clercq on 28 March 2021, this review provides an overview of his contributions to eight approved nucleos(t)ide drugs: (i) three adenosine nucleotide analogues, namely tenofovir disoproxil fumarate (Viread ®) and tenofovir alafenamide (Vemlidy ®) against HIV and HBV infections and adefovir dipivoxil (Hepsera ®) against HBV infections; (ii) two thymidine nucleoside analogues, namely brivudine (Zostex ®) against HSV-1 and VZV infections and stavudine (Zerit ®) against HIV infections; (iii) two guanosine analogues, namely valacyclovir (Valtrex ®, Zelitrex ®) against HSV and VZV and rabacfosadine (Tanovea ®-CA1) for the treatment of lymphoma in dogs; and (iv) one cytidine nucleotide analogue, namely cidofovir (Vistide ®) for the treatment of HCMV retinitis in AIDS patients. Although adefovir dipivoxil, stavudine, and cidofovir are virtually discontinued for clinical use, tenofovir disoproxil fumarate and tenofovir alafenamide remain the most important antivirals against HIV and HBV infections worldwide. Overall, the broad-spectrum antiviral potential of nucleos(t)ide analogues supports their development to treat or prevent current and emerging infectious diseases worldwide.

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          EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection.

          Hepatitis B virus (HBV) infection remains a global public health problem with changing epidemiology due to several factors including vaccination policies and migration. This Clinical Practice Guideline presents updated recommendations for the optimal management of HBV infection. Chronic HBV infection can be classified into five phases: (I) HBeAg-positive chronic infection, (II) HBeAg-positive chronic hepatitis, (III) HBeAg-negative chronic infection, (IV) HBeAg-negative chronic hepatitis and (V) HBsAg-negative phase. All patients with chronic HBV infection are at increased risk of progression to cirrhosis and hepatocellular carcinoma (HCC), depending on host and viral factors. The main goal of therapy is to improve survival and quality of life by preventing disease progression, and consequently HCC development. The induction of long-term suppression of HBV replication represents the main endpoint of current treatment strategies, while HBsAg loss is an optimal endpoint. The typical indication for treatment requires HBV DNA >2,000IU/ml, elevated ALT and/or at least moderate histological lesions, while all cirrhotic patients with detectable HBV DNA should be treated. Additional indications include the prevention of mother to child transmission in pregnant women with high viremia and prevention of HBV reactivation in patients requiring immunosuppression or chemotherapy. The long-term administration of a potent nucleos(t)ide analogue with high barrier to resistance, i.e., entecavir, tenofovir disoproxil or tenofovir alafenamide, represents the treatment of choice. Pegylated interferon-alfa treatment can also be considered in mild to moderate chronic hepatitis B patients. Combination therapies are not generally recommended. All treated and untreated patients should be monitored for treatment response and adherence, and the risk of progression and development of complications. HCC remains the major concern for treated chronic hepatitis B patients. Several subgroups of patients with HBV infection require specific focus. Future treatment strategies to achieve 'cure' of disease and new biomarkers are discussed.
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            Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance.

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                Author and article information

                Contributors
                Role: Academic Editor
                Role: Academic Editor
                Role: Academic Editor
                Journal
                Molecules
                Molecules
                molecules
                Molecules
                MDPI
                1420-3049
                09 February 2021
                February 2021
                : 26
                : 4
                : 923
                Affiliations
                [1 ]Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, China; liguangdi.research@ 123456gmail.com
                [2 ]Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha 410078, China; yuetingting@ 123456csu.edu.cn (T.Y.); paulazhang@ 123456csu.edu.cn (P.Z.)
                [3 ]Laboratory of Medicinal Chemistry, Rega Institute for Medicinal Research, KU Leuven, 3000 Leuven, Belgium; weijie.gu@ 123456kuleuven.be (W.G.); Ling-jie.gao@ 123456kuleuven.be (L.-J.G.)
                Author notes
                [* ]Correspondence: tanli@ 123456csu.edu.cn ; Tel.: +86-0731-8529-2142
                Author information
                https://orcid.org/0000-0001-8852-034X
                https://orcid.org/0000-0002-2868-0787
                https://orcid.org/0000-0003-3706-7404
                https://orcid.org/0000-0001-8889-3621
                Article
                molecules-26-00923
                10.3390/molecules26040923
                7916218
                33572409
                05c75f71-2890-4eaa-b0ae-b26c3a3949f5
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 22 December 2020
                : 05 February 2021
                Categories
                Review

                antiviral therapy,nucleoside analogue,nucleotide analogue,hiv,hbv,hcv,hsv,vzv,hcmv

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