October 19, 2020

Anti-virals

Treating viruses with antivirals is different than treating bacterial infections with antibiotics. Not so simple as taking penicillin for 10 days to cure strep throat, and not so clear if the antivirals even work.

We have learned so much about viruses in the 35 plus years since the HIV epidemic began. New targets in cells were identified and treatments developed. But finding “cures” is not easy. Yes, we have learned to manage and control HIV infections with a combination of meds to prevent AIDS from developing, but cure is still elusive. (There are a couple of exceptions but that is another story). Finally after decades of research, meds were found that can cure Hepatitis C, but curing Hepatitis B is still not been achieved. We can prevent it with vaccines and control it with some meds, but we can’t clear it. Partly it is because there are many different types of viruses, so different targets need to be discovered and then meds designed. Still elusive for the common cold and other viruses.

I bring this up because 3 different studies released over the past couple of months have conflicting results regarding remdesivir effectiveness. The latest and largest study from the World Health Organization shows no difference with treatments in shortening the length or severity. Disappointing. But another study published in JAMA in August shows that remdesivir if given for 5 days is effective in improving the infection and another published in the NEJM just last week supports that remdesivir is effective in “shortening the course”.

What are we to think? I like to consider what happens when we treat the flu with the med known as Tamiflu. The sooner one starts it the faster the recovery from influenza. That means it cuts down fever and body ache by 1-2 days, but if it is started too late (48 hours or more after becoming ill) Tamiflu makes no difference.

The same with valacyclovir for shingles, the faster you start it, the faster you heal, but if meds are delayed more than 2-3 days after the rash starts, little to no benefit is seen. I saw this recently with Jamie’s shingles- he got the meds on board within an hour or two and never developed blisters and recovered fairly quickly. Lucky for him.

I experienced the same effect of antivirals, when I took them after a needle stick from an HIV patient with a high viral load. (Viral load is the amount of virus in a milliliter of blood). I started them within and hour or two and remained virus free. Miraculous, really.

It looks like the remdesivir is most effective when given early in the infection, which means we need better access to tests and faster results. Using remdesivir seems to help people avoid the high viral loads that can lead to the hyper immune response that can be deadly. Remdesivir seems safe and doesn’t have a lot of side effects.

So much knowledge already for a virus less than a year old but still so many questions.

Wash your hands, cover your nose, keep safe six, and stay sensible.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

https://www.medrxiv.org/content/10.1101/2020.10.15.20209817v1

https://www.nejm.org/doi/full/10.1056/NEJMoa2007764

https://jamanetwork.com/journals/jama/fullarticle/2769871

https://blogs.jwatch.org/hiv-id-observations/index.php/does-remdesivir-actually-work/2020/10/18/