Antiviral agents: advances and problems

This is the first special topic volume, collected from articles within Progress and Drug Research dealing with new antiviral agents. The editors have chosen an important range of topics – concentrating on only one aspect of HIV (a good idea given the breadth of antivirals for HIV), and agents for influenza, hepatitis C, hepatitis B, herpesviruses and picornaviruses. Although the range of topics is broad, most of the authors come from pharmaceutical companies, particularly the Lilly Research Laboratories at Eli-Lilly in Indianapolis. In fact, authors of four of the six chapters are members of the Eli-Lilly Research Laboratories, one is from the Roche Research Laboratories in Hertfordshire, and one from the University of Southern California. The reviews all tend towards academic discussion of the pharmacologic uses of drugs. Further, all the authors approach the subject from the point of view of drug design and use, rather than from a clinical standpoint with drug design based upon response to clinical needs. This is not a criticism of the authors' approach, but readers need to be aware that emphasis is more on biochemical rather than clinical drug design. In general, the chapters deal with important issues, and have brief summaries of the virology at the start, followed by more detailed discussion of different types of drug classes, and individual representatives of these classes. Who would find this book useful? The book is very much aimed at a specialist reader with knowledge of pharmacology, rather than a clinical audience. The discussion of HIV protease inhibitors is good, although the rapid change in HIV therapy means any book chapter will be rapidly out-of-date. The chapter on influenza drugs was excellent, although more discussion of the use of these agents in pandemic situations (such as arose with H5 influenza in Hong Kong during 1997) would be of interest. The discussion of hepatitis C was useful, although the evolution of treatment of hepatitis C means multi drug therapy is now standard, and it would be useful to have further discussion of what may be next. Furthermore, recent developments in the treatment of acute HCV infection, and new indicators of response to treatment, mean this chapter lacked discussion of some evolving and important areas. The chapter on herpesviruses dealt with the basic issues well, although several areas of treatment such as the use of valganciclovir, intravitreal ganciclovir, and animal models for testing of herpesviruses were deficient. It was disappointing not to see some discussion of vaccines as there has been considerable literature regarding vaccination, particularly for HSV infection, particularly in the last three years. The picornavirus chapter was adequate, although there was less discussion of drugs such as pleconaril (which is now in limited clinical use) than would be useful to the general reader. Overall, the specialist pharmacologist, or a clinician interested in a particular area of antiviral research, would do well to start with one of these chapters relating to their area of interest. The major weakness of the book is the rapid rate of advance in antiviral therapy – particularly for HIV, hepatitis C and the herpesviruses. This will be a weakness of any book, although the provision of addenda immediately prior to publication can be of use in reducing this problem. What I liked about this book was the excellent overall structure, dealing with the most important antivirals available in 2001. Selection of one area of HIV therapy for more detailed discussion was a wise choice, and utilization of review style articles to make up the book, made for in-depth reading. The problems with this book were that in many areas it was incomplete (such as for anti viral agents for herpesviruses), the lack of any significant reference to vaccination, and the dense nature of the material. The book would benefit from more summary tables for occasional readers. It was striking that new vaccines for influenza (adjuvanted, intranasal, and others), HSV, and HIV were not mentioned. The referencing style, where article titles were not given was also annoying, given that a target audience for this book may well look to the references for further information about particular areas that they find of interest within each chapter. Overall, Antiviral Agents: Advances and Problems is a reasonable book in a difficult field. The information is readable, the authors provide significant detail in the areas they cover, and the references are in general inclusive. It would be a useful book for the reader looking for a succinct introduction to one of the six major areas covered in the chapters, or looking for further information about the pharmacology of these antiviral agents.