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Review
. 2010 Jun;24(2):413-37.
doi: 10.1016/j.idc.2010.01.001.

Antiviral drug resistance: mechanisms and clinical implications

Lynne Strasfeld  1 , Sunwen Chou
Affiliations
Review

Antiviral drug resistance: mechanisms and clinical implications

Lynne Strasfeld et al. Infect Dis Clin North Am. 2010 Jun.

Corrected and republished in

Abstract

Antiviral drug resistance is an increasing concern in immunocompromised patient populations, where ongoing viral replication and prolonged drug exposure lead to the selection of resistant strains. Rapid diagnosis of resistance can be made by associating characteristic viral mutations with resistance to various drugs as determined by phenotypic assays. Management of drug resistance includes optimization of host factors and drug delivery, selection of alternative therapies based on knowledge of mechanisms of resistance, and the development of new antivirals. This article discusses drug resistance in herpesviruses and hepatitis B.

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Figures

Figure 1
Figure 1
Map of CMV UL97 gene functional domains and resistance mutations. Ganciclovir resistance (GCVr) mutations are clustered at codons 460, 520 and 590–607. In the latter region mutations A594V, L595S, C592G and C603W are some of the most common, but a variety of point and in-frame deletion mutations are known to confer varying degrees of GCV resistance. Not all sequence changes at codons 590–607 confer ganciclovir resistance.
Figure 2
Figure 2
Map of CMV DNA polymerase functional domains, resistance mutations, and associated phenotypes. All listed mutations have been found in clinical isolates and validated by recombinant phenotyping. Shaded regions indicate where resistance mutations are clustered, with associated phenotypes indicated below. Updated from [92]. GCVr = ganciclovir resistance. CDVr = cidofovir resistance. FOSr = foscarnet resistance.
Figure 3
Figure 3
Map of HBV polymerase gene functional domains (terminal protein, spacer, Pol/rt = polymerase/reverse transcriptase, RNaseH), catalytic subdomains (A–G), and resistance mutations.
See this image and copyright information in PMC

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