Queens' College, Cambridge, UK.
Br Med Bull. 2013;106:213-49. doi: 10.1093/bmb/ldt011. Epub 2013 Apr 17.
Background Herpesviruses notably establish lifelong infections, with latency and reactivation. Many of the known human herpesviruses infect large proportions of the population worldwide. Treatment or prevention of herpes infections and recurrent disease still pose a challenge in the 21st century. Sources of data Original papers and review articles, meeting abstracts, a book (Clinical Virology; DD Richman, RJ Whitley & FG Hayden eds) and company web sites. Areas of agreement For herpes simplex types 1 and 2 and for varicella zoster, acyclovir (ACV; now increasingly replaced by its prodrug valacyclovir, VACV) and famciclovir (FCV) have greatly reduced the burden of disease and have established a remarkable safety record. Drug-resistance, in the otherwise healthy population, has remained below 0.5% after more that 20 years of antiviral use. In immunocompromised patients, drug resistance is more common and alternative drugs with good safety profiles are desirable. For human cytomegalovirus disease, which occurs in immunocompromised patients, ganciclovir and increasingly its prodrug valganciclovir are the drugs of choice. However, alternative drugs, with better safety, are much needed. Areas of controversy Various questions are highlighted. Should the new 1-day therapies for recurrent herpes labialis and genital herpes replace the current standard multi-day therapies? The marked differences between VACV and FCV (e.g. triphosphate stability, effect on latency) may not yet be fully exploited? Do current antivirals reduce post-herpetic neuralgia (PHN)? For immunocompromised patients with varicella zoster virus (VZV) disease, should the first-line treatment be FCV, not ACV or VACV? Should there be more support to explore new avenues for current antivirals, for example in possibly reducing herpes latency or Alzheimer's disease (AD)? Should primary Epstein-Barr virus (EBV) disease in adolescents be treated with antivirals? How can new compounds be progressed when the perceived market need is small but the medical need is great. FCV was reclassified from prescription-only to pharmacist-controlled for herpes labialis in New Zealand in 2010; should this be repeated more widely? This article reviews new drugs in clinical trials and highlights some of the problems hindering their progress.
疱疹病毒会导致终身感染，并存在潜伏和再激活的现象。全球范围内，许多已知的人类疱疹病毒感染了很大一部分人群。在 21 世纪，治疗或预防疱疹感染和复发性疾病仍然是一个挑战。
原始论文和综述文章、会议摘要、一本书（《临床病毒学》，DD Richman、RJ Whitley 和 FG Hayden 编著）以及公司网站。
对于单纯疱疹病毒 1 型和 2 型以及水痘-带状疱疹病毒，阿昔洛韦（ACV；现在已被其前体药物伐昔洛韦（VACV）和泛昔洛韦（FCV）广泛取代）和泛昔洛韦（FCV）已大大降低了疾病负担，并具有卓越的安全性记录。在 20 多年的抗病毒治疗后，在健康人群中，药物耐药性仍保持在 0.5%以下。在免疫功能低下的患者中，药物耐药性更为常见，需要具有良好安全性的替代药物。对于免疫功能低下的患者发生的人巨细胞病毒疾病，更昔洛韦和越来越多的其前体药物缬更昔洛韦是首选药物。然而，需要更好的安全性的替代药物。
突出了各种问题。新的 1 天疗法用于复发性唇疱疹和生殖器疱疹是否应替代当前的标准多日疗法？VACV 和 FCV（例如三磷酸酯稳定性、对潜伏的影响）之间的明显差异可能尚未得到充分利用？当前的抗病毒药物是否能减轻疱疹后神经痛（PHN）？对于患有水痘-带状疱疹病毒（VZV）疾病的免疫功能低下的患者，一线治疗应该是泛昔洛韦，而不是阿昔洛韦或伐昔洛韦？是否应该有更多的支持来探索当前抗病毒药物的新途径，例如可能减少疱疹潜伏或阿尔茨海默病（AD）？青少年原发性 EBV 疾病是否应使用抗病毒药物治疗？当感知到的市场需求很小但医疗需求很大时，如何推进新化合物的发展？2010 年，新西兰将泛昔洛韦从处方药重新分类为药剂师控制的疱疹性唇炎药物；是否应该更广泛地重复这一做法？本文综述了临床试验中的新药，并强调了一些阻碍其进展的问题。
