Antiviral Consideration for Transplantation Including Drug Resistance

Antiviral therapy is required in the transplant setting for viral infections that arise from preexisting latent or persistent infection in the recipient and/or donor as well as from nosocomial or community sources. A preventive or prophylactic antiviral approach where feasible is preferable to the treatment of symptomatic viral disease. Acute infections need prompt diagnosis and antiviral treatment for the best outcome. Selection of antiviral therapy involves multiple considerations including potential benefit, toxicity, logistical complexity, and the possibility of drug resistance. This chapter reviews antiviral drug therapy for the most common viruses affecting transplant recipients: herpesviruses including herpes simplex virus, varicella-zoster virus, and cytomegalovirus, influenza, respiratory syncytial virus (RSV), and hepatitis viruses B and C. The mechanism of action, major pharmacologic features, therapeutic uses related to transplant recipients, and genetic pathways of antiviral drug resistance are described for the FDA-approved drugs and some experimental compounds in late stage clinical trial.