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The field of antiviral therapy—both the number of antiviral drugs and our understanding of their optimal use—continues to lag behind the field of antibacterial drug treatment, in which 70 years of experience have now been accumulated, but significant progress has been made in recent years on new drugs for several viral infections. The development of antiviral drugs poses several challenges. Viruses replicate intracellularly and often employ host cell enzymes, macromolecules, and organelles for synthesis of viral particles. Therefore, useful antiviral compounds must discriminate between host and viral functions with a high degree of specificity; agents without such selectivity. | Chapter 171. Antiviral Chemotherapy Excluding Antiretroviral Drugs Introduction The field of antiviral therapy both the number of antiviral drugs and our understanding of their optimal use continues to lag behind the field of antibacterial drug treatment in which 70 years of experience have now been accumulated but significant progress has been made in recent years on new drugs for several viral infections. The development of antiviral drugs poses several challenges. Viruses replicate intracellularly and often employ host cell enzymes macromolecules and organelles for synthesis of viral particles. Therefore useful antiviral compounds must discriminate between host and viral functions with a high degree of specificity agents without such selectivity are likely to be too toxic for clinical use. The development of laboratory assays to assist clinicians in the appropriate use of antiviral drugs is also in its early stages. Phenotypic and genotypic assays for resistance to antiviral drugs are becoming more widely available and correlations of laboratory results with clinical outcomes in various settings are beginning to be defined. Of particular note has been the development of highly sensitive and specific methods that measure the concentration of virus in blood virus load and permit direct assessment of the antiviral effect of a given drug regimen in that compartment in the host. Virus load measurements have been useful in recognizing the risk of disease progression in patients with certain viral infections and in identifying patients to whom antiviral chemotherapy might be of greatest benefit. Like any in vitro laboratory test these tests yield results that are highly dependent on and likely to vary with the laboratory techniques employed. Information regarding the pharmacokinetics of some antiviral drugs particularly in diverse clinical settings is limited. Assays to measure the concentrations of these drugs especially of their active moieties within cells are .
