Abstract
Although there are effective nucleoside analogs to treat HSV, VZV, and HCMV disease, herpesvirus infections continue to contribute to significant morbidity and mortality. Acyclovir is the drug of choice for HSV encephalopathy, yet there is an estimated 6–19% mortality rate with half of the survivors experiencing moderate to severe chronic neurological deficits. For VZV, current treatments are inadequate to prevent acute and persistent pain due to zoster. Treatment of HCMV with GCV requires close monitoring particularly in patients with impaired renal function and there are no approved treatments for congenital HCMV infections. New therapeutic options to control cytomegalovirus reactivation in bone marrow and stem cell transplant patients are needed to improve patient outcome. No successful chemotherapeutic options are available for EBV, HHV-6, 7, and 8. Drug resistance is a concern for HCMV, HSV, and VZV since approved drugs share common mechanisms of action. Targeting DNA encapsidation or capsid assembly provide additional options for the development of non-nucleoside, small molecule anti-herpesviral drugs.
Highlights
Reviewed by: Jocelyne Piret, Research Center of the CHU de Québec, Canada Gualtiero Alvisi, University of Padua, Italy
There are effective nucleoside analogs to treat HSV, varicellazoster virus (VZV), and HCMV disease, herpesvirus infections continue to contribute to significant morbidity and mortality
Successful Phase II and III clinical trials resulted in approval of letermovir in the United States, Canada, Japan, Switzerland, and the European Commission for the prevention of HCMV infection and disease in adult HCMVseropositive recipients of an allogeneic hematopoietic stem cell transplant (Maffini et al, 2016; Fuji et al, 2017; Chen et al, 2018; Cho et al, 2018; El Helou and Razonable, 2019; Katayama and Iwato, 2019; Ljungman et al, 2019; Mori, 2019)
Summary
Reviewed by: Jocelyne Piret, Research Center of the CHU de Québec, Canada Gualtiero Alvisi, University of Padua, Italy. There are effective nucleoside analogs to treat HSV, VZV, and HCMV disease, herpesvirus infections continue to contribute to significant morbidity and mortality. The recent approval of letermovir offers a new treatment option for HCMV in allogeneic stem cell transplant patients (see below).
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