Hsv, Vzv

Key points

• SOURCE-INTEGRITY NOTE: this page is titled for HSV/VZV but its captured source is a fragment of an antiviral drug table plus antiretroviral drug classes. The intended HSV/VZV content is NOT present anywhere in this package. HSV/VZV material that IS present: genital herpes (STI: Ulcers) and chickenpox exposure in pregnancy.
• Antiviral fragment retained for reference: GANCICLOVIR — guanosine analogue, phosphorylated by viral kinase, inhibits viral DNA polymerase · used for CMV · major toxicity is MYELOSUPPRESSION/agranulocytosis. Aciclovir toxicity: crystalline nephropathy. Ribavirin: guanosine analogue inhibiting inosine monophosphate dehydrogenase.
• NRTI examples — HISTORICAL and no longer current UK first-line: zidovudine (AZT), didanosine, stavudine, zalcitabine · still in current use: lamivudine, emtricitabine, tenofovir.
• PROTEASE INHIBITORS inhibit the protease needed for viral maturation · historical examples: indinavir, nelfinavir, saquinavir · of these only ritonavir persists in current practice, and then as a pharmacokinetic BOOSTER rather than as an active agent. Boosted DARUNAVIR is the PI used in current UK first-line regimens.
• NNRTI examples: nevirapine, efavirenz — both HISTORICAL as first-line; efavirenz is specifically no longer recommended first-line in the current BHIVA guidelines. For current UK first-line therapy see the HIV: Anti-Retrovirals chapter.