ABSTRACT

Introduction: Acyclovir has led to the development of successful systemic therapy for herpes simplex virus and varicella-zoster virus (VZV) infection, and the use of valacyclovir and famciclovir has improved treatment. Additionally, the use of a helicase-primase (HP) inhibitor (HPI), amenamevir, is changing the treatment of herpes zoster (HZ).

Area covered: VZV infection is prevented by vaccines and is treated with antiviral agents. Acyclovir and penciclovir are phosphorylated by viral thymidine kinase and work as chain terminators. Improvements in the management of immunocompromised patients have reduced severe and prolonged immunosuppression and chronic VZV infection with acyclovir-resistant mutants has become rarer. The HP is involved in the initial step of DNA synthesis and amenamevir has novel mechanisms of action, efficacy to acyclovir-resistant mutants, and pharmacokinetic characteristics. The literature search for PUBMED was conducted on 10 April 2020 and updated on 4 November 2020.

Expert opinion: Amenamevir has been used to treat HZ in Japan. Although the number of patients with VZV infection will decrease owing to the use of vaccines, the addition of HPI will improve treatment and treatment options for resistant viruses. The clinical use of HPIs in addition to current nucleoside analogs opens a new era of antiherpes therapy.

摘要

简介: 阿昔洛韦导致单纯疱疹病毒和水痘-带状疱疹病毒 (VZV) 感染的成功全身治疗的发展，伐昔洛韦和泛昔洛韦的使用改善了治疗。此外，使用解旋酶引发酶 (HP) 抑制剂 (HPI) 阿米那韦正在改变带状疱疹 (HZ) 的治疗。

覆盖区域：疫苗可预防 VZV 感染，并使用抗病毒药物进行治疗。阿昔洛韦和喷昔洛韦被病毒胸苷激酶磷酸化并作为链终止剂。免疫功能低下患者管理的改进减少了严重和长期的免疫抑制，阿昔洛韦耐药突变体的慢性 VZV 感染变得越来越少。HP 参与 DNA 合成的初始步骤，amenamevir 具有新的作用机制、对阿昔洛韦耐药突变体的功效和药代动力学特征。PUBMED 的文献检索于 2020 年 4 月 10 日进行，并于 2020 年 11 月 4 日更新。

专家意见：阿美那韦在日本已被用于治疗 HZ。尽管由于使用疫苗，VZV 感染患者的数量会减少，但 HPI 的添加将改善耐药病毒的治疗和治疗选择。除了目前的核苷类似物外，HPI 的临床应用开启了抗疱疹治疗的新纪元。