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Countering antiviral drug resistance must be a priority within COVID-19 management

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Antiviral drugs are the first line of defence for several life-threatening conditions.

As the scientific community finds encouraging results within vaccine development to counter the spread of the COVID-19 pandemic, it is crucial for continued multisectoral collaboration to address antimicrobial resistance as a priority. COVID-19 may not be the last of the virus outbreaks that we as a community would witness. While it is impossible to predict when its likelihood must push us to adopt the highest order of antimicrobial (and antiviral) stewardship within which we must identify best practices to avoid the spread of superbugs and drug-resistant infections.

While the U.S. Food and Drug Administration approved the first antiviral medication for the treatment of COVID-19, it came as a result of more than a decade of research, experimentation and iteration by Gilead’s scientists. Prior to being identified for treatment, Gilead’s scientists had been studying its impact in haemorrhagic fever syndromes caused by Ebola and Marburg viruses as well as other diseases caused by other coronaviruses such as SARS and MERS. This work allowed Gilead to move very quickly into COVID-19 clinical trials when the novel coronavirus emerged. Gilead has a long-term commitment to advancing antivirals innovation for almost three decades.

Antivirals are the first line of defence for several life-threatening conditions including HIV and Hepatitis. When viruses resist a medication, it makes infections harder to treat, increasing the cost of treatment with second and third lines, it will also increase the risk of illness and possible death. In countries where the healthcare industry is underregulated, misuse of medicines and poor sanitary conditions have accelerated this phenomenon.

Antiviral resistance and noncompliance to therapeutic guidelines are significant causes of treatment failure in patients across disease areas. This is concerning especially within impoverished and immune-compromised patient populations, where ongoing viral replication and prolonged drug exposure lead to the selection of resistant strains to antivirals.

How antiviral drugs work vary, ranging from targeting viral proteins to cellular proteins and strengthening the immune response, alongside several types of interferons, immunoglobulins, and vaccines, to the viral infection. While immunisation programmes support against identifiable strains and subtypes, they however will not be able to replicate success against unseen types. While some form of viral resistance against any specific and potent drug is virtually might be inevitable, we can work to minimise it. To prevent worst-case scenarios, combination drug therapy and prophylaxis are often proposed to stem and challenge emerging antiviral resistance.

It is also important to beat viruses as early as possible, as antiviral drugs may not work as well in viruses with reduced susceptibility, or sometimes the virus replication phase is happening at the first stage of the disease like what we have seen in COVID 19. As the virus progresses and mutates, when treatments are not being delivered promptly, testing and diagnostics remain very important, as patients with COVID-19 display symptoms shared with several other diseases, the importance of starting antiviral treatment as early as possible emerges. Attention must be paid towards ensuring the continuation of child and adult vaccination services to protect from other forms of infections and diseases, applying rigorous hygiene procedures when being administered. While sanitising is heavily encouraged during the pandemic, the overuse of biocidal agents for environmental and personal disinfection can select for drug-resistant strains and enhance the risk of cross resistance.

Antiviral resistance is not only a cost to the healthcare system, but it deprives the patient of the full value and therapeutic benefit of the years of innovation and expenditure that went into the drug’s development. To ensure that regional healthcare systems are able to realise their strategic goals of universal health coverage, there must be industry-wide investments made to encourage assays, diagnostic procedures, therapeutic regimen and clinical guidelines that are endorsed and vetted by the relevant medical community within adopting antimicrobial stewardship as we move closer to beating COVID-19. 

References available on request

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Ayman Elsayes

This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today.  

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