Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is spreading worldwide with different clinical manifestations. Age and comorbidities may explain severity in critical cases and people living with human immunodeficiency virus (HIV) might be at particularly high risk for severe progression. Nonetheless, current data, although sometimes contradictory, do not confirm higher morbidity, risk of more severe COVID-19 or higher mortality in HIV-infected people with complete access to antiretroviral therapy (ART). A possible protective role of ART has been hypothesized to explain these observations. Anti-viral drugs used to treat HIV infection have been repurposed for COVID-19 treatment; this is also based on previous studies on severe acute respiratory syndrome virus (SARS-CoV) and Middle East respiratory syndrome virus (MERS-CoV). Among them, lopinavir/ritonavir, an inhibitor of viral protease, was extensively used early in the pandemic but it was soon abandoned due to lack of effectiveness in clinical trials. However, remdesivir, a nucleotide analog that acts as reverse-transcriptase inhibitor, which was tested early during the pandemic because of its wide range of antiviral activity against several RNA viruses and its safety profile, is currently the only antiviral medication approved for COVID-19. Tenofovir, another nucleotide analog used extensively for HIV treatment and pre-exposure prophylaxis (PrEP), has also been hypothesized as effective in COVID-19. No data on tenofovir’s efficacy in coronavirus infections other than COVID-19 are currently available, although information relating to SARS-CoV-2 infection is starting to come out. Here, we review the currently available evidence on tenofovir’s efficacy against SARS-CoV-2.
Highlights
COVID-19, caused by the severe acute respiratory syndrome virus 2 (SARS-CoV-2), has been defined as a pandemic around the world by theWorld Health Organization (WHO)
At the beginning of the pandemic, hydroxychloroquine [108] and lopinavir/ritonavir [8], two old drugs approved for other clinical uses, were extensively used for COVID-19 treatment but were quickly not recommended further [10,11,12,109]
Remdesivir, which was tested early in the pandemic because of its wide range of antiviral activity against several RNA viruses and its safety profile, is currently the only antiviral medication approved for COVID-19 [7]
Summary
COVID-19 (coronavirus disease 2019), caused by the severe acute respiratory syndrome virus 2 (SARS-CoV-2), has been defined as a pandemic around the world by the. These polyproteins are cleaved by two viral protea protease (PLpro) and the main protease or 3C-like protease (Mpro/3 non-structural proteins (nsp1–16) Most of these proteins are involve replication cycle of SARS-CoV-2, in particular, nsp is the RNA de merase (RdRp) that with the cofactors nsp and nsp performs vira translation and synthesis of structural and accessory proteins and new virions [4,5,6] (Figure 1). Virions are uncoated and viral RNA is released in the cytosol and immediately translated into two large polyproteins, pp1a and pp1ab, specified by two large open reading frames of the viral RNA, ORF1a and ORF1b Both polyproteins contain the amino acid sequences of viral non-structural proteins (nsps). We review the currently available evidence on tenofovir efficacy against SARS-CoV-2
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