Non-HIV Antiviral Agents

Abstract

During the past several decades, viruses have been increasingly recognized as frequent and important pathogens. Critically ill and immunocompromised patients, particularly within the transplant and human immunodeficiency virus (HIV)-infected populations, are at particularly high risk for severe viral infections such as those caused by cytomegalovirus (CMV), adenovirus, disseminated herpes simplex virus (HSV), and infections with hepatitis B virus (HBV) and hepatitis C virus (HCV). Influenza continues to be a significant public and global health ­problem as well. Many of the currently available antiviral agents have been in clinical use for many years and clinical data related to important drug interactions often concern the use of older drugs with which significant interactions were likely to frequently occur (e.g., zidovudine, didanosine). Unfortunately, however, interaction data are often unavailable for drugs such as the newer antiretroviral and immunosuppressant agents which are now considered standards of care for management of populations at high risk for serious viral infections. Some of the non-HIV antiviral drugs such as acyclovir, famciclovir, oseltamivir, and amantadine are associated with relatively few clinically significant drug interactions. However, there are a number of significant interactions which must be considered for the safe and effective use of drugs such as ganciclovir, foscarnet, cidofovir, ribavirin, and the interferons. This chapter summarizes available data regarding pharmacokinetic and toxic interactions with the current non-HIV antiviral agents.