Chapter 40: Antiviral Drugs

The discussion of non-HIV antivirals covers nucleoside analogs like acyclovir and ganciclovir, which inhibit viral DNA polymerase and are used for herpes simplex virus, varicella-zoster virus, and cytomegalovirus infections, along with neuraminidase inhibitors such as oseltamivir and zanamivir that interrupt influenza virus release from infected cells. Ribavirin and sofosbuvir represent broader antiviral strategies targeting respiratory syncytial virus and hepatitis C virus respectively, with sofosbuvir marking a paradigm shift in direct-acting antiviral therapy that has dramatically improved cure rates. The chapter extensively addresses HIV infection and the progressive immunosuppression leading to AIDS, establishing why combination antiretroviral therapy is essential for viral suppression and immune reconstitution. Antiretroviral drug classes are systematically presented including nucleoside and non-nucleoside reverse transcriptase inhibitors that block viral replication machinery, protease inhibitors that prevent maturation of infectious viral particles, fusion and entry inhibitors that block cell invasion, and integrase inhibitors that prevent viral DNA integration into the host genome. Understanding the mechanism of each drug class illuminates why combination therapy with agents from different classes is required to overcome viral resistance and maintain long-term therapeutic efficacy. The chapter addresses critical nursing responsibilities including comprehensive patient assessment for contraindications and drug interactions, vigilant monitoring for adverse effects such as bone marrow suppression and nephrotoxicity, and patient education emphasizing lifelong adherence to prevent resistance development and transmission. Finally, the emerging treatment landscape for coronavirus disease is presented, highlighting remdesivir, monoclonal antibody therapies, and oral antiviral options that demonstrate how antiviral pharmacology evolves to address novel pathogens and global health emergencies.