Infectious Disease Drugs

By:Mohamad Ashraf S.Ismail

Antiviral Agents : HIV/AIDS

The end stage of infection with human immunodeficiency virus is acquired immune deficiency syndrome (AIDS) Attacks the bodies immune system and it makes it weak , enough to allow for unusual or prolonged infection. Globally, 85% of HIV transmission is heterosexual.

In order to understand HIV and AIDS, it is important to understand the meanings behind these terms:

HIV stands for the human immunodeficiency virus. It is one of a group of viruses known as retroviruses. After getting into the body, the virus kills or damages cells of the body's immune system. The body tries to keep up by making new cells or trying to contain the virus, but eventually the HIV wins out and progressively destroys the body's ability to fight infections and certain cancers. AIDS stands for the acquired immunodeficiency syndrome. It is caused by HIV and occurs when the virus has destroyed so much of the body's defenses that immune-cell counts fall to critical levels or certain life-threatening infections or cancers develop.

HIV/AIDS Transmission
Most commonly, HIV infection is spread by having sex with an infected partner. The virus can enter the body through the lining of the vagina, vulva, penis, rectum, or mouth during sex. HIV frequently spreads among injection-drug users who share needles or syringes that are contaminated with blood from an infected person. Women can transmit HIV to their babies during pregnancy or birth, when infected maternal cells enter the baby's circulation. HIV can be spread in health-care settings through accidental needle sticks or contact with contaminated fluids. Very rarely, HIV spreads through transfusion of contaminated blood or blood components. Blood products are now tested to minimize this risk. If tissues or organs from an infected person are transplanted, the recipient may acquire HIV. Donors are now tested for HIV to minimize this risk. People who already have a sexually transmitted disease, such as syphilis, genital herpes, chlamydial infection, gonorrhea, or bacterial vaginosis, are more likely to acquire HIV infection during sex with an infected partner. The virus does not spread through casual contact such as preparing food, sharing towels and bedding, or via swimming pools, telephones, or toilet seats. The virus is also unlikely to be spread by contact with saliva, unless it is contaminated with blood.

HIV Symptoms and Signs

Many people do not develop symptoms after they first get infected with HIV. Others have a flu-like illness within several days to weeks after exposure to the virus. They complain of fever, headache, tiredness, and enlarged lymph nodes in the neck. These symptoms usually disappear on their own within a few weeks. After that, the person feels normal and has no symptoms. This asymptomatic phase often lasts for years. The progression of disease varies widely among individuals. This state may last from a few months to more than 10 years. During this period, the virus continues to multiply actively and infects and kills the cells of the immune system. The virus destroys the cells that are the primary infection fighters, a type of white blood cell called CD4 cells.

AIDS Symptoms and Signs

AIDS is the later stage of HIV infection, when the body begins losing its ability to fight infections. Once the CD4 cell count falls low enough, an infected person is said to have AIDS. Sometimes, the diagnosis of AIDS is made because the person has unusual infections or cancers that show how weak the immune system is.

The infections that happen with AIDS are called opportunistic infections because they take advantage of the opportunity to infect a weakened host. The infections include (but are not limited to)

pneumonia caused by Pneumocystis, which causes wheezing; brain infection with toxoplasmosis which can cause trouble thinking or symptoms that mimic a stroke; widespread infection with a bacteria called MAC (mycobacterium avium complex) which can cause fever and weight loss; yeast infection of the swallowing tube (esophagus) which causes pain with swallowing; widespread diseases with certain fungi like histoplasmosis, which can cause fever, cough, anemia, and other problems.

A weakened immune system can also lead to other unusual conditions:

lymphoma in (a form of cancer of the lymphoid tissue) the brain, which can cause fever and trouble thinking; a cancer of the soft tissues called Kaposi's sarcoma, which causes brown, reddish, or purple spots that develop on the skin or in the mouth.

HIV/AIDS Diagnosis
HIV infection is commonly diagnosed by blood tests. There are three main types of tests that are commonly used: (1) antibody tests, (2) RNA tests, and (3) a combination test that detects both antibodies and a piece of the virus called the p24 protein.

HIV/AIDS Treatment
Over the past years, several drugs have become available to fight both the HIV infection and its associated infections and cancers. These drugs are called highly active antiretroviral therapy (HAART) and have substantially reduced HIVrelated complications and deaths. However, there is no cure for HIV/AIDS. Therapy is initiated and individualized under the supervision of a physician who is an expert in the care of HIVinfected patients. A combination of at least three drugs is recommended to suppress the virus from replicating and boost the immune system.

The following are the different classes of medications used in treatment.

Reverse transcriptase inhibitors: These drugs inhibit the ability of the virus to make copies of itself. The following are examples: o Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs). These include medications such as zidovudine (AZT/Retrovir), didanosine (ddI/Videx), zalcitabine (ddC/Hivid), stavudine (d4T/Zerit), lamivudine (3TC/Epivir), abacavir (ABC/Ziagen), emtricitabine (FTC/Emtriva), and tenofovir (Viread). o Non-nucleoside reverse transcriptase inhibitors (NNRTIS) are commonly used in combination with NRTIs to help keep the virus from multiplying. Examples of NNRTIs are efavirenz (Sustiva), nevirapine (Viramune), and delavirdine (Rescriptor). Etravirine (Intelence), a newer member of this class of drugs, was approved by the U.S. FDA in 2008.

 Protease inhibitors (PIs): These medications interrupt virus replication at a later step in its life cycle, preventing cells from producing new viruses. These include ritonavir (Norvir), a lopinavir and ritonavir combination (Kaletra), saquinavir (Invirase), indinavir sulphate (Crixivan), amprenavir (Agenerase), fosamprenavir (Lexiva), darunavir (Prezista), atazanavir (Reyataz), tipranavir (Aptivus), and nelfinavir (Viracept). Using PIs with NRTIs reduces the chances that the virus will become resistant to medications. Fusion and entry inhibitors are newer agents that keep HIV from entering human cells. Enfuvirtide (Fuzeon/T20) was the first drug in this group. It is given in injectable form like insulin. Another drug called maraviroc (Selzentry) binds to a protein on the surface of the human cell and can be given by mouth. Both drugs are used in combination with other anti-HIV drugs. Integrase inhibitors stop HIV genes from becoming incorporated into the human cell's DNA. This is a newer class of drugs recently approved to help treat those who have developed resistance to the other medications. Raltegravir (Isentress) was the first drug in this class approved by the FDA in 2007.

Antiretroviral viral drugs stop viral replication and delay the development of AIDS. However, they also have side effects that can be severe. They include decreased levels of red or white blood cells, inflammation of the pancreas, liver toxicity, rash, gastrointestinal problems, elevated cholesterol level, diabetes, abnormal body-fat distribution, and painful nerve damage.

Pregnant women who are HIV-positive should seek care immediately because HAART therapy reduces the risk of transmitting the virus to the fetus. There are certain drugs, however, that are harmful to the baby. Therefore, seeing a physician to discuss antiHIV medications is crucial.

Tuberculosis
Tuberculosis (TB) is an infection caused by slowgrowing bacteria that grow best in areas of the body that have lots of blood and oxygen. Thats why it is most often found in the lungs. This is called pulmonary TB. But TB can also spread to other parts of the body, which is called extrapulmonary TB.

A TB patient-covers-her-mouth-to-preventspreading-the-disease

What is Tuberculosis? Tuberculosis, sometimes referred to as TB, is a disease caused by an organism called mycobacterium tuberculosis. The mycobacterium tuberculosis bacteria can attack any part of the body, but most commonly attack the lungs.

Tuberculosis
Latent TB Active TB

Tuberculosis treatment

refers to the medical treatment of the infectious disease tuberculosis (TB).

The most common drugs used for active tuberculosis are: Isoniazid (INH) Rifampin (RIF) Ethambutol Pyrazinamide. For a person with latent tuberculosis, treatment usually consists of taking isoniazid for at least six months.

 Take antibiotics for 6-12 months Preventative drug to destroy dormant bacteria Vaccines(relatively ineffective today) If not treated, active TB can be fatal, killing up to 60% of patients. When treated, a cure can be achieved in 90% of all cases.

Hepatitis
Simply put, hepatitis is an inflammation of the liver. This inflammation can be caused by several factors including: medications viruses exposure to chemicals environmental toxins autoimmune disorders alcohol use

Hepatitis can be categorized into two types:

Acute Hepatitis Facts about acute hepatitis include:
a sudden or gradual onset is short-lived, usually lasting less than two months liver damage is usually mild on rare occasions can be fatal in some circumstances can progress to chronic hepatitis.

Chronic Hepatitis
Facts about chronic hepatitis includes:
persists for long periods of time classified as either
chronic persistent - usually mild and slow to progress but can become more severe progressing to chronic acute hepatitis chronic acute - as liver damage becomes more extensive and severe, chronic active hepatitis can cause cirrhosis, most often resulting in liver failure and even death

7 Types of viral Hepatitis

Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Hepatitis F Hepatitis G

Hepatitis A
Formally known as infectious hepatitis, this form is always acute and never becomes chronic. Hep A is transmitted by contact with infected feces, food or water that has been contaminated. Often Hep A is a result of poor hand washing techniques among food preparation workers at restaurants. The risk of contracting Hep A can be reduced with a series of vaccines.

How hepatitis A is spread

The hepatitis A virus (HAV) is found in the faeces of someone infected with the virus. It only takes a tiny amount of faeces getting inside another persons mouth to cause hepatitis A infection. Personal hygiene, such as careful hand washing, can minimise the risk of the virus being passed on. HAV is a common infection in many parts of the world where sanitation and sewage infrastructure is poor. Often people become infected with HAV by eating or drinking contaminated food or water. Hepatitis A is also classed as a sexually transmitted disease (STD) because it can be passed on sexually, particularly during activities such as anilingus (rimming). The washing of genital and anal areas before sex, and the use of condoms or dental dams can help to prevent this risk. Hepatitis A can affect all age groups. Once a person is exposed to the virus it takes between 2 and 6 weeks to produce symptoms.

Signs and symptoms of hepatitis A

It is possible to experience mild or no symptoms whatsoever, but even if this is the case the persons faeces will still be infectious to others. Many people who become infected with HAV will have symptoms that include: A short, mild, flu-like illness; nausea, vomiting and diarrhoea; loss of appetite; weight loss; jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces); itchy skin; abdominal pain. The infection usually clears in up to 2 months, but may occasionally recur or persist longer in some people. Once a person has been infected and their body has fought off the virus they are permanently immune. Occasionally symptoms may be severe and require monitoring in hospital. There are rarely any complications with hepatitis A infection. Permanent damage to the liver is very unlikely, but in extremely rare cases the infection can be fatal, particularly in older people.

Treatment for hepatitis A

There is no specific treatment for HAV and most people fight off the virus naturally, returning to full health within a couple of months. The doctor will advise avoiding alcohol and fatty foods as these can be hard for the liver to process and may exacerbate the inflammation. Patients should get plenty of rest and eat a nutritious diet. They should also ensure they do not spread HAV by washing their hands after using the toilet and before preparing food. Patients with more severe symptoms may be monitored in hospital for a short period.

Hepatitis B
Formally known as serum hepatitis Hep b is transmitted via sexual contact, saliva, contaminated needles used by drug users and exposure to infected blood. Hep B often will progress to a chronic hepatitis without showing signs of active hepatitis. The risk of contracting Hep B can be reduced with a series of vaccines.

How hepatitis B is spread

The hepatitis B virus (HBV) is very common worldwide, with more than 350 million people infected. Those with long term HBV are at high risk of developing liver cirrhosis or liver cancer. Hepatitis B is most frequently passed on through the exchange of bodily fluids with an infected person. HBV is estimated to be 50 to 100 times more infectious than HIV.1 HBV can be spread in the following ways: By unprotected (without a condom) penetrative sex (when the penis enters the anus, vagina or mouth) with someone who is infectious. Also by sex that draws blood with someone who is infected. By sharing contaminated needles or other drug-injecting equipment. By using non-sterilised equipment for tattooing, acupuncture or body piercing. From an infected mother to her baby, most commonly during delivery. Immunisation of the baby at birth prevents the transmission of hepatitis B. Through a blood transfusion in a country where blood is not screened for blood-borne viruses such as HBV. Hepatitis B cannot be spread through sneezing, coughing, hugging or coming in contact with the faeces of someone who is infected.

Signs and symptoms of hepatitis B

Many people who become infected with HBV experience mild symptoms or no symptoms at all, but they may still carry the infectious virus and pass it on to others. When symptoms do appear they are similar to those of hepatitis A and may include: A short, mild, flu-like illness; nausea, vomiting and diarrhoea; loss of appetite; weight loss; jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces); itchy skin. If symptoms become severe then a person with hepatitis B may be admitted to hospital. Most adults infected with the hepatitis B virus fully recover and develop life-long immunity. Between 2% and 10% of individuals infected as adults will become chronic carriers, which means they will be infectious to others and can develop chronic liver damage. Infected children, especially newborn babies, are much more likely to become chronic carriers. If a person lives with hepatitis B infection for a number of years then they may develop the following complications: chronic hepatitis liver cirrhosis liver cancer

Treatment for hepatitis B

In the majority of patients with active HBV, symptoms will not be severe and treatment will not be required. The patient will be monitored and after a few months the patients immune system should fight off the virus, giving the patient natural immunity. In around 5% of adults, 30-50% of young children (aged 1-4), and 90% of infants, HBV infection will become chronic. The virus is more deadly to the young and those that are infected at birth have a 25% chance of developing a life-threatening liver-related illness. Antiviral medication is given as treatment to those with chronic symptoms to help prevent further liver damage. These medications may be injected or given in pill form. Examples are Interferon Alpha, Lamivudine and Baraclude. Treatment usually lasts 6 months, during which time the patient will be carefully monitored. Regardless of whether the infection is producing symptoms or not, the patient will be advised to avoid alcohol, get plenty of rest and maintain a healthy diet.

Hepatitis C
At one time, Hep C was transmitted by receiving blood transfusions. But with the advent of blood screening tests, that mode of transmission is very rare. Now Hep C is transmitted primarily by sharing contaminated needles and syringes between intravenous drug users. It can also be transmitted by sexual contact with someone already infected, or by occupational exposure via needlesticks. Hep C is a chronic hepatitis that often shows no acute stage. Infection with Hep C can go undetected without symptoms for years. Many scientists believe that Hep C will become the next public health crisis.

How hepatitis C is spread

The hepatitis C virus (HCV) can be spread in the following ways: By sharing drug-injecting equipment (needles, heating spoons, etc). This is the primary transmission route for HCV outside sub-Saharan Africa. By using non-sterilised equipment for tattooing, acupuncture or body piercing. This can be a problem in countries where tattooing or scarification is a traditional ritual practice. Through exposure to blood during unprotected sex with an infected person. Blood may be present because of genital sores, cuts or menstruation. Sexual transmission is an uncommon way of becoming infected with hepatitis C. Rarely, from an infected mother to her baby during childbirth. The risk may be greater if the mother is also infected with HIV. Through blood transfusion. In many developing countries blood is not screened (tested) for the hepatitis C virus. All blood for transfusion in the UK and USA is tested. By sharing equipment used to snort cocaine. Usually this is a rolled banknote, which can become contaminated with blood from a persons nose. Hepatitis C cannot be passed on by hugging, sneezing, coughing, sharing food or water, sharing cutlery, or casual contact.

Signs and symptoms of hepatitis C

Many people do not have symptoms when they become infected with hepatitis C. Symptoms may emerge later, taking anywhere between 15 and 150 days to develop. Occasionally a person will not develop any symptoms and their immune system will successfully clear the virus without their knowledge. An infected person without symptoms can still act as a carrier and pass the virus on to others. Symptoms may include: A short, mild, flu-like illness; nausea and vomiting; diarrhoea; loss of appetite; weight loss; jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces); itchy skin. About 20% of individuals who become infected with HCV will clear the virus from their body within 6 months, though this does not mean they are immune from future infection with HCV. The other 80% of people will develop chronic hepatitis C infection, during which the virus may cause mild symptoms or no symptoms at all. These people will however carry the hepatitis C virus for the rest of their lives and will remain infectious to others. If a person lives with hepatitis C infection for a number of years then they may develop the following complications: chronic hepatitis liver cirrhosis liver cancer If symptoms become severe then a person with hepatitis C may be admitted to hospital for monitoring and treatment.

Treatment combines the antiviral drugs interferon and ribavirin. Although treatment has improved in recent years, the success rates vary depending on which genotype the patient has and how long they have had hepatitis C. In 2011, the FDA approved a new drug called Victrelis (for the treatment of the genotype 1 strain of hepatitis C). When taken alongside existing drugs, Victrelis cured more than 60 percent of patients in clinical trials compared to between 20-40 percent of patients when existing drugs were taken alone.3 Unlike other drugs for hepatitis C, Victrelis is a protease inhibitor, similar to those used to treat HIV. Adherence to this drug is essential to prevent drug resistance. The antiviral drugs may cause significant side effects that may be intolerable for some people. These include: headaches flu-like symptoms nausea tiredness body aches depression skin rashes A patient will also require regular check-ups to monitor their progress. It is important to remember that if HCV treatment is effective and the infection is cleared, this does not mean the patient has future immunity to hepatitis C.

Treatment for hepatitis C

Interferon
Interferon is a cytokine, a specific protein that is no stranger to the human body. In fact, the human body is constantly making interferon, and makes even greater amounts when trying to fight off an intruder, such as a virus. People experience this when suffering with the flu. When sick with the flu, the body makes extra interferon to defeat the virus causing the illness. The extra interferon causes symptoms such as fever, nausea, achy and sore muscles, joint pain and fatigue. This is called an antiviral effect. Interferon therapy is currently the gold standard in treatment for certain types of hepatitis B and C.

How Does it Work?

While the interferon used for hepatitis treatment is slightly different from the kind made in the body, it helps defeat the virus in three ways: 1. By attaching to healthy cells to help defend against invading viruses. 2. By helping the immune system to stop the virus from multiplying. 3. By assisting the body in ridding itself of infected cells while preventing healthy cells from being infected.

Interferon helps the body distinguish between cells infected by the virus and noninfected cells, targeting infected cells for destruction. For unknown reasons, a virus in the liver often becomes invisible to the immune system. If your body can't see the virus, it can't destroy it. This invisibility permits the virus to multiply within the liver, fostering a more chronic and severe infection. Scientists have learned that if they gave synthetic (created through genetic engineering) interferon to a person with chronic viral hepatitis, they could increase the immune system's ability to detect, or see, the infection. Imagine liver cells blending in with invaders, both a clear transparent color. The addition of interferon is like staining the infection deep red, highlighting them so they can be targeted for the immune system's fighter cells. Interferon also helps patients with viral hepatitis by directly suppressing the formation of new virus particles within the liver.

What kinds are there?

Scientists have determined that the body makes three distinct types of interferon; alpha, beta and gamma interferon, each containing several members. Alpha interferon has been approved for therapeutic use against a specific type of leukemia, hepatitis B and C, genital warts, AIDS- related Kaposi's sarcoma and some rare cancers of blood and bone marrow. Nasal sprays containing alpha interferon provide some protection against colds caused by rhinoviruses. There are two primary types of interferon currently available. To date, interferon-alpha 2a or 2b is the compound that has been extensively used and tested. Though the dose varies, patients with chronic hepatitis C usually receive 3 million units, three times per week. Individuals with chronic hepatitis B receive a higher dose of 10 million units, three times per week. Although it can widely vary, the typical duration of therapy is 48 weeks for hepatitis C, and 16 weeks for hepatitis B. A newer formulation on the market is called pegylated interferon. This drug was developed in response to the fall in blood levels, rapid breakdown and subsequent loss of antiviral effect of interferon given 3 times per week. By attaching a molecule called polyethylene glycol to interferon-alpha 2a or 2b, researchers were able to slow its breakdown by the body. More consistent drug levels were achieved with the need to only give the drug once per week. Above and beyond the convenience of once a week injection, the pegylated formulations also result in higher viral clearance rates.

Side Effects
Interferon used for hepatitis treatment -- alpha and pegylated forms -- have been known to cause severe side effects, including:

* worsening of psoriasis * irritability and insomnia * trouble breathing * chest pain * high fever and chills * fatigue * headaches * decreased appetite, nausea and vomiting * weight loss * muscle aches * bone marrow suppression * weight and hair loss * depression and mood changes * decreased white blood cells and platelets * elevated liver enzymes * difficulty concentrating and impaired memory