Antivirals and antiviral strategies

Key Points

• In this article, the usefulness, or potential usefulness, of the currently licensed antiviral drugs and those in clinical or preclinical development is evaluated. The main conclusions are:

• For the treatment of polyomavirus, papillomavirus, adenovirus and poxvirus infections, the acyclic nucleoside phosphonates such as cidofovir have the greatest potential.

• For the treatment of HSV and VZV infections, (val)acyclovir, famciclovir and brivudin are important.

• For the treatment of CMV infections, (val)ganciclovir, cidofovir and foscarnet are the most promising.

• Ribavirin is proposed for the treatment of (−)RNA virus (such as arenavirus and bunyavirus) infections, whereas IFN and IFN inducers are envisaged for the treatment of (+)RNA virus infections, particularly picornavirus (for example, coxsackie B) and togavirus (for example, Western, Eastern and Venezuelan equine encephalitis virus) infections.

• For the treatment of HCV infections, pegylated IFN, in combination with ribavirin, is currently recommended, although compounds targeted at the HCV protease and RNA-dependent RNA polymerase have also been developed.

• For the therapy and prophylaxis of influenza virus infections, the neuraminidase inhibitors zanamivir and oseltamivir are the current drugs of choice.

• Among the paramyxoviruses, human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) are the viruses for which antiviral therapy is most required. Although ribavirin is available for the treatment of RSV infections, it is not ideal, and therefore, new compounds are required for the treatment of hMPV and RSV infections.

• A plethora of 'old' and 'new' compounds are available or are being developed for the treatment of HIV infections. Multiple drug regimens might be beneficial for HIV treatment.

• For other virus infections —rotavirus, and Ebola, Marburg and other haemorrhagic virus infections — the choice of potential antiviral agents is rather limited, however, SAH hydrolase inhibitors such as 3-deazaneplanocin A are currently the most promising.

Supplementary information

The online version of this article (doi:10.1038/nrmicro975) contains supplementary material, which is available to authorized users.

Abstract

In recent years, the demand for new antiviral strategies has increased markedly. There are many contributing factors to this increased demand, including the ever-increasing prevalence of chronic viral infections such as HIV and hepatitis B and C, and the emergence of new viruses such as the SARS coronavirus. The potential danger of haemorrhagic fever viruses and eradicated viruses such as variola virus being used as bioterrorist weapons has also increased the profile of antiviral drug discovery. Here, the virus infections for which antiviral therapy is needed and the compounds that are available, or are being developed, for the treatment of these infections are described.

Supplementary information

The online version of this article (doi:10.1038/nrmicro975) contains supplementary material, which is available to authorized users.