Andrei G, Snoeck R
Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
Adv Pharmacol. 2013;67:107-68. doi: 10.1016/B978-0-12-405880-4.00004-4.
Varicella-zoster virus (VZV) causes two distinct diseases, varicella (chickenpox) and shingles (herpes zoster). Chickenpox occurs subsequent to primary infection, while herpes zoster (usually associated with aging and immunosuppression) appears as a consequence of reactivation of latent virus. The major complication of shingles is postherpetic neuralgia. Vaccination strategies to prevent varicella or shingles and the current status of antivirals against VZV will be discussed in this chapter. Varivax®, a live-attenuated vaccine, is available for pediatric varicella. Zostavax® is used to boost VZV-specific cell-mediated immunity in adults older than 50 years, which results in a decrease in the burden of herpes zoster and pain related to postherpetic neuralgia. Regardless of the availability of a vaccine, new antiviral agents are necessary for treatment of VZV infections. Current drugs approved for therapy of VZV infections include nucleoside analogues that target the viral DNA polymerase and depend on the viral thymidine kinase for their activation. Novel anti-VZV drugs have recently been evaluated in clinical trials, including the bicyclic nucleoside analogue FV-100, the helicase-primase inhibitor ASP2151, and valomaciclovir (prodrug of the acyclic guanosine derivative H2G). Different candidate VZV drugs have been described in recent years. New anti-VZV drugs should be as safe as and more effective than current gold standards for the treatment of VZV, that is, acyclovir and its prodrug valacyclovir.
水痘带状疱疹病毒（VZV）可引发两种不同的疾病，即水痘和带状疱疹。水痘发生于初次感染之后，而带状疱疹（通常与衰老和免疫抑制相关）则是潜伏病毒重新激活的结果。带状疱疹的主要并发症是带状疱疹后神经痛。本章将讨论预防水痘或带状疱疹的疫苗接种策略以及抗VZV抗病毒药物的现状。Varivax®是一种减毒活疫苗，可用于儿童水痘预防。Zostavax®用于增强50岁以上成年人的VZV特异性细胞介导免疫，从而减轻带状疱疹的负担以及与带状疱疹后神经痛相关的疼痛。无论是否有疫苗可用，新型抗病毒药物对于治疗VZV感染都是必要的。目前批准用于治疗VZV感染的药物包括靶向病毒DNA聚合酶且依赖病毒胸苷激酶激活的核苷类似物。新型抗VZV药物最近已在临床试验中进行评估，包括双环核苷类似物FV-100、解旋酶-引发酶抑制剂ASP2151以及伐昔洛韦（无环鸟苷衍生物H2G的前药）。近年来已描述了不同的候选VZV药物。新型抗VZV药物应与治疗VZV的当前金标准药物（即阿昔洛韦及其前药伐昔洛韦）一样安全且更有效。
