Antiviral Agents, Vaccines and Immunotherapies - S. Tyring (CRC, 2005) WW.pdf - Medycyna, ludzkie ciało - adam001d

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Preface

The development of antiviral drugs is still in its infancy with

rapid changes and progressive milestones encountered almost

daily. By the time this book is distributed, new drugs may

have already been added. This is particularly true for the anti-

retroviral drugs, which seem to be growing in number expo-

nentially to the casual observer trying to keep abreast of

recent advances in this ﬁeld. As this book is going to press, the

United States Food and Drug Administration granted acceler-

ated approval of Epzicom and Truvada. Epzicom is a ﬁxed-

dose combination of the antiretroviral drugs Ziagen (abacavir

sulfate) and Epivir (lamivudine). Truvada is a ﬁxed-dose com-

bination of Emtriva (embricitabine) and Viread (tenofovir dis-

oproxil fumarate). In keeping pace with these advances, the

book will survey the latest in antiretroviral drugs, general

antiviral therapies, the antiviral vaccines, and immunothera-

pies used for treatment, and prophylaxis of viral infections.

The book begins with a review of the current state of anti-

viral management (therapy and prophylaxis) and discussion

of the challenges for the future. The second chapter discusses

the major categories as well as the indications, adverse reac-

tions, and drug interactions of each speciﬁc medication of the

iii

Preface

antiretroviral drugs. Chapter Three delves into the treat-

ments available for other viral infections, such as herpes sim-

plex virus, varicella zoster virus, cytomegalovirus, human

papilloma virus, chronic viral hepatitis, and others. The book

then concludes with a discussion of the vaccines that are cur-

rently available and being developed and gives an overview of

the use of immunoglobulins and monoclonal antibodies for

antiviral therapy.

The last two decades have been the most dynamic in the

history of viral infections and their management. During this

time the eradication of the epidemic form of the most deadly

viral infection known to medicine, smallpox, was announced.

Ironically, this landmark achievement was followed almost

immediately by the observation of a new viral pandemic that

currently infects 46 million people, i.e., HIV/AIDS. Within the

past decade several new emerging viral diseases, e.g., West

Nile virus, SARS, avian inﬂuenza, etc., have challenged our

ability to recognize and manage these infections. Unfortu-

nately, antiviral drugs have been effective for only a few

groups of viruses up until now. Most antiviral drugs do not

produce a cure, but rather allow control of the infection. An

exception to this observation has recently been seen with the

combined use of pegylated interferon alpha and ribavirin,

which allows virologic cures for the majority of hepatitis C

patients who successfully complete therapy. However, the lim-

itations of antiviral therapy, including the high costs of drugs,

make the need for prevention even more urgent. The most cost

effective means of prevention are public health measures,

such as proper sanitation/clean drinking water, mosquito con-

trol, testing blood/blood products, not sharing needles, and

safer sex/condom use. In addition, vaccines provide the most

effective and cost-efﬁcient means of preventing infectious dis-

eases. The greatest success story in medical history was the

eradication of epidemic smallpox, which was due to a com-

bined effort of public health measures and an effective vac-

cine. For such combined efforts to eradicate other viral

diseases, such as measles and polio, the challenges are not

only to reach the susceptible populations but also to overcome

unfounded prejudice against vaccines. At the same time, new

Preface

technologies will lead to the development of new prophylactic

vaccines, particularly for infections such as HIV, human pap-

illomaviruses, and herpes simplex viruses, ushering in a

whole new set of arsenals in the ﬁght against viral infections.

It is my hope that Antiviral Agents, Vaccines, and Immuno-

therapies will serve as a valuable tool for the clinician and the

basic scientist in better understanding the current manage-

ment protocols of viral diseases as well as greater possibilities

for the future.

Stephen K. Tyring, MD, PhD, MBA

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