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Drugtreatment
ofviralinfectiousdiseasesBingDuGanRanXingJiBingDeYaoWuZhi
LiaoLecturer/Teacher
XXKnowledgeobjective:Tomasterthecommontreatmentdrugsanddrugtreatmentprinciplesforviralhepatitis,acquiredimmunodeficiency,herpeszosterandhand-foot-and-mouth
disease.Abilityobjective:toguidepatientstousedrugsrationally.Curriculumideologicalandpoliticalobjective:
thecurrentstateofthe
virus→Fearnatureandremain
modestLearning
objectivesAcquiredimmunodeficiencysyndromeHerpeszosterhand-foot-and-mouth
diseaseViral
hepatitisTreatmentof
COVID-19AcquiredimmunodeficiencysyndromeHerpeszosterhand-foot-and-mouth
diseaseViral
hepatitisViral
hepatitisHerpes
zosterAcquiredimmunodeficiency
syndromeHand-foot-and-mouth
diseaseAcquiredimmunodeficiencysyndromeHerpeszosterhand-foot-and-mouth
diseaseViral
hepatitisDisease
overviewConcept:Viralhepatitisisatypeofinfectiousdiseasecausedbyhepatitisvirusinfection,divided HepatitisA(causedbyHAV
infection)into:HepatitisB(causedbyHBVinfection):epidemicin
ChinaHepatitisC(causedbyHCVinfection):epidemicinwestern
countriesHepatitisD(causedbyHDV
infection)HepatitisE(causedbyHEV
infection)AcquiredimmunodeficiencysyndromeHerpeszosterhand-foot-and-mouth
diseaseViral
hepatitisDisease
overviewClinical
manifestations:AnorexiaGreasyaversionNauseaEpigastricdiscomfortFatigueHepatalgiaAbnormalliverfunctionJaundice
andfever(some
patients)AcquiredimmunodeficiencysyndromeHerpeszosterhand-foot-and-mouth
diseaseViral
hepatitisCommontherapeutic
drugsAntiviral
drugsMechanismof
action:Doseandtreatment
course:①Produce
antiviral
protein
to
inhibit
virus
replication;
②Regulate
immunity,
enhance
andpromotetheactivityofnaturalkillercells,cytotoxicTcellsand
macrophages.OrdinaryIFN-α,3~5MU,3times/weekor1timeeveryotherday,subcutaneousorintramuscularinjection,withtreatmentcourseof1yearor
longer.PEG-IFNα2a,180μg,orPEG-IFNα2b,1.5μg/kg,subcutaneous
injection,
1
time
a
week,
with
treatment
courseof1yearor
longer.AcquiredimmunodeficiencysyndromeHerpeszosterhand-foot-and-mouth
diseaseViral
hepatitisCommontherapeutic
drugsAntiviral
drugsα
interferon(IFN-α)Adverse
reactions:ThyroiddysfunctionCardiovascularcomplicationsretinopathyAutoimmunediseasesandrarekidneydamageMental
disorderMyelosuppressionFlu-likesyndromeHearing
lossAcquiredimmunodeficiencysyndromeHerpeszosterhand-foot-and-mouth
diseaseViral
hepatitisCommonlyuseddrugs:Lamivudine,Adefovir,Entecavir,TelbivudineandTenofovir.Mechanismofaction:inhibitviralpolymeraseorreverse
transcriptaseDoseand
courseDrug
nameDosageandmethodof
administrationLamivudineOral administration, 100mg/time, 1time/dayAdefovirOral administration, 10mg/time, 1time/dayEntecavirOral administration, 0.5mg/time, 1time/dayTelbivudineOral administration, 600mg/day, 1time/dayTenofovirOral administration, 300mg/day, 1time/dayCommontherapeutic
drugsAntiviral
drugsNucleotide
analoguesAcquiredimmunodeficiencysyndromeHerpeszosterhand-foot-and-mouth
diseaseViral
hepatitisCommontherapeutic
drugsAntiviral
drugsAnti-inflammatoryandhepatoprotective
drugsCommonlyused
drugs:PolyenoicacidphosphatidylcholinecapsuleB
vitaminsSilymarinpreparationsGlycyrrhizic
acidpreparationsGlucurolactoneGlutathioneAcquiredimmunodeficiencysyndromeHerpeszosterhand-foot-and-mouth
diseaseViral
hepatitisApplicationprinciplesoftherapeutic
drugsIndicationsforantiviraltherapyofhepatitis
BHBV-DNA≥105copies(104copies/mlfor
HBeAg-negative)ALT≥2timestheupperlimitof
normalLiverhistologyshowedKnodellHAI≥4,or≥G2inflammatory
necrosisPatients
with
①
and②
or
③
shouldreceiveantiviraltherapyAcquiredimmunodeficiencysyndromeHerpeszosterhand-foot-and-mouth
diseaseViral
hepatitisApplicationprinciplesoftherapeutic
drugsIndicationsforantiviraltherapyofhepatitisC:AllpatientswithpositiveHCV-RNAtestshouldbetreatedwithantiviral
therapy.Treatment
course:HBeAg-positive chronic hepatitis B: The treatment course of nucleotide analogues isrecommendedtobeatleast1yearaftereantigen
seroconversionHBeAg-negativechronichepatitisB:Thetreatmentcourseofnucleotideanaloguesisatleast
2yearsAcquiredimmunodeficiencysyndromeHerpeszosterhand-foot-and-mouth
diseaseViral
hepatitisPrecautionsfor
medicationInterferonandribavirincancauseteratogenicorembryoniclethaleffects.Therefore,duringtreatmentandwithin6monthsoftreatment,allwomenandmenofchildbearingagemusttakecontraceptive
measuresInterferonandribavirincancauseteratogenicorembryoniclethaleffects.Therefore,duringtreatmentandwithin6monthsoftreatment,allwomenandmenofchildbearingagemusttakecontraceptive
measuresDNA
levelsHepatitisCtreatmentrequiresregularmonitoringofliverfunction,HCV-RNAlevels,TSHandbloodlipid
levelsViral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseViral
hepatitisHerpes
zosterAcquiredimmunodeficiency
syndromeHand-foot-and-mouth
diseaseViral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseCase
analysisCase:
Patient,
male,
45
years
old.
4
years
ago,
due
to
family
poverty,
he
went
out
to
workandsoldbloodmanytimesduringtheperiod.Afterearningmoney,hereturnedtohishometown,gotmarriedandhadchildren.Withlowfeveraccompaniedbyfatigue,anorexia
and
weight
loss,
he
was
admitted
to
the
hospital
for
more
than
months.
Physicalexamination:Perilabialpallor,oralmucosacoveredwithwhitemembranes,largejointdeformitiesofextremities.Laboratoryexamination:WBC2.5×109/L,HGB75g/L。Diagnosedas
AIDS.Viral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseCase
analysisDiscussion:1.StatetheinfectionrouteofAIDSacquiredbythepatientinthecase.
Isitpossibleforhisfamilymemberstobeinfected?
Why?2.WhatarethedrugsforAIDS
treatment?Viral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseDisease
overviewConcept:Acquiredimmunodeficiencysyndrome(AIDS),orAIDS,isaninfectiousdiseasecausedbyhumanimmunodeficiencyvirus(HIV)
infection.Infection
processAdsorptionandpenetrationCircularizationandintegrationTranscriptionand
translationAssembly,maturation
and
buddingViral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseDisease
overviewClinicalmanifestationsAcute
stage2~4weeksaftertheinitialHIV
infection.Clinicalmanifestationsincludefever,skinrash,lymphadenopathy,nausea,vomitingandneurologicalsymptoms,etc.,whichwillberelievedafter1~3
weeksHIVantigenandHIVRNAcanbefound,andHIVantibodyispositiveforabout2~6
weeksViral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseDisease
overviewClinicalmanifestationsAsymptomatic
stage•••Lastsfor6~8yearsorlonger,andthelengthoftimeisrelatedtothenumberandtypeofvirusinfection,theimmunestatusofthebody,therouteofinfection,nutritionalconditionsandother
factorsCD4+Tlymphocytecountdecreased
graduallyContagiousViral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseDisease
overviewClinicalmanifestationsAIDS
stageFinalstageafterbeinginfectedwith
HIVAvarietyoffatalopportunisticinfectionsandmalignanttumors
appearMainmanifestations:fever,diarrhea,nightsweats,significantweightloss,systemiclymphadenopathylastingmorethan1
month,etc.Somepatientsshowedneuropsychiatric
symptoms.CD4+lymphocytecountin
patients<200/μl.Viral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseCommontherapeuticdrugs(antiviral
drugs)Nucleosidereversetranscriptaseinhibitors(NRTIs)Commonlyuseddrugs:Lamivudine,Tenofovir,Abacavir,Zidovudine,Emtricitabine,
etc.Mechanismofaction:ThesedrugsarephosphorylatedtoformtriphosphatecompoundswithcompetitiveinhibitionofHIVreversetranscriptase
activity,blockHIVreversetranscription,andinhibitthesynthesisofviraldouble-stranded
DNAViral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseCommontherapeuticdrugs(antiviral
drugs)Non-nucleosidereversetranscriptaseinhibitors
(NNRTIs)Commonlyuseddrugs:Nevirapine,Efavirenz,Etravirin,Ripavirin,
etc.Mechanismofaction:bindtothehydrophobicregionneartheactivesiteofHIVreversetranscriptaseandinterfereswiththeactivityofthe
enzymeViral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseCommontherapeuticdrugs(antiviral
drugs)Proteaseinhibitors
(PIs)Commonlyuseddrugs:Ritonavir,Tiranavir,Atazanavir,Darunavir,Lopinavir,
etc.Mechanismofaction:inhibittheactivityofprotease,sothatthenewlyproducedHIVcannot
matureViral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseCommontherapeuticdrugs(antiviral
drugs)Fusioninhibitors
(FIs)Commonlyuseddrugs:
EnfuvirtideMechanismofaction:actontheoutsideofCD4+TcellstopreventHIVfrominvadingcells.WhenHIVbindstotheCD4+cellreceptor,theviralmembraneandCD4+cellmembraneapproachandfuse,andviralparticlesenterthecell.FIsinterferewiththisinvasionprocessbyinhibitingthefusionofHIVviruswithhost
cells.Viral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseCommontherapeuticdrugs(antiviral
drugs)Proteaseinhibitors
(PIs)Commonlyuseddrugs:Ritonavir,Tiranavir,Atazanavir,Darunavir,Lopinavir,
etc.Mechanismofaction:inhibittheactivityofprotease,sothatthenewlyproducedHIVcannotmatureViral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseCommontherapeuticdrugs(antiviral
drugs)Fusioninhibitors
(FIs)Commonlyuseddrugs:
EnfuvirtideMechanismofaction:actontheoutsideofCD4+TTcellstopreventHIVfrominvadingcells.WhenHIVbindstotheCD4+cellreceptor,theviralmembraneandCD4+cellmembraneapproachandfuse,andviralparticlesenterthecell.FIsinterferewiththisinvasionprocessbyinhibitingthefusionofHIVviruswithhost
cells.
Others:IntegraseinhibitorLategravir,CCR5antagonist,
etc.Viral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseApplicationprinciplesoftherapeutic
drugsClarifythetherapeutictargetof
antiviralReducetheincidenceandmortalityofHIV-relateddiseases,andreduce
theincidenceandmortalityofnon-AIDS-relateddiseases,sothatpatientscangetnormallifeexpectancy
andimprovethequalityoflifeRebuildormaintainimmune
functionInhibitviralreplicationtoreduceviralloadtothelowerlimitofdetectionandreducevirus
mutationReduceabnormalimmune
activationReduceHIVtransmissionandpreventmothertochild
transmissionViral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseApplicationprinciplesoftherapeutic
drugsComprehensive
therapyPsychotherapyPrevention
andtreatmentofopportunisticinfectionAnti-HIV
therapy(key)SupportivetreatmentViral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseApplicationprinciplesoftherapeutic
drugsTimingofinitiationofantiviraltherapyinadultsand
adolescentsAcute
stageThepatienthasclinical
symptomsAsymptomaticstageCD4+Tlymphocyte<500/μL,
orCD4+Tlymphocyte>500/μLbutwithadecreaseofCD4+T-lymphocytes100/μLperyear,viral
load>105copies/mL,combinedHBV/HCVinfection,pregnancy,HIV-relatednephropathy,andhighriskofcardiovascular
diseaseRecommendedschemefornewpatient:2NRTIs+1
NNRTIsViral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseApplicationprinciplesoftherapeutic
drugsPrinciplesofapplicationoftherapeuticdrugsEvaluationofefficacyofantiviral
therapyVirologic
indicators:Immunologicalindexes:Clinical
symptoms:Plasmaviralloaddecreasesbymorethan1Lgwithin4weeksandreachesundetectablelevelsafter3to6months—themostimportantindicatorforefficacy
evaluation100
/μL
increase
in
CD4+
T
lymphocytes
1
year
after
treatment
or
30%
increase
in
CD4+T-lymphocytecount3monthsaftertreatmentcomparedto
pre-treatmentWeight
gain
is
the
most
sensitive
indicator
for
evaluating
the
efficacy
of
antiviral
therapy,andchildrencanbe
evaluatedcomprehensively in combination with nutritional, height and developmentalViral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseAderversedrug
reactionsGastrointestinalsymptomsAllergic
reactionsPeripheralneuropathy(morecommoninnucleosidedrugs
)Liver
toxicityLacticacidtoxicityreactionOthers:Efavirenzcancauseabnormaldreams,daydreamsandpersonalitychanges;Zidovudineispronetocausefatigue,headache,andanemia;PatientstakingIndinavircanhavedryskin,crackedlips,thinninghair,
etc.Viral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseViral
hepatitisHerpes
zosterAcquiredimmunodeficiency
syndromeHand-foot-and-mouth
diseaseViral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseDisease
overviewConcept:herpeszosterischickenpoxthatlurksintheneuronsoftheposteriorrootganglionofthehumanspinal
cord-Skindiseasescausedbyherpeszostervirus(VZV).Mostofthemarefoundinthe
middle-agedandoldmen
overtheageof
50Predilectionsite:Innervationareaofintercostal,cervical,trigeminaland
lumbosacralnerves,arrangedinabandalongaperipheralnerve,andmostofthemarefoundononesideofthebody,generallynotexceedingthemedian
line.Localskinburning,sensitizationorpain(withgeneralmalaiseorfever)→irregular
erythemaoflocalskin→clustersofmiliarypapules
→blistersCourseofdisease:2~3
weeksPrognosis:Temporarypaleerythemaorpigmentation,neuralgia(nerve
paralysis)Viral
hepatitisAcquiredimmunodeficiency
syndromeHerpes
zosterhand-foot-and-mouthdiseaseCommonlyusedtreatment
drugsDrug
nameDosageandmethodof
administrationAcyclovirOral administration, 0.4g, 5 times/day; Creatinine clearancerateof10~25ml/min,3times/day;Creatinineclearance<
10ml/min,2
times/dayValacyclovirOraladministration,1g,3times/dayAcetaminophenOraladministration.300~600mg/timesforadults.Onceevery4~6hours.Nomorethan2g/dayforthe
elderly.IbuprofenOraladministration.200~400mg/timesfora
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