12I CNGVic cha tr hu ht cc bnh do virus gy ra vn cn I vn d kh khn cho khoa hc hin dai.Hin nay vn chi c gng tm ra thuc chng nga. 3I CNG S sao chp ca virus ty thuc vo qu trnh chuyn ha ca t bo k ch Thuc dit virus tn hai dn k ch. i vi bnh AIDS :* Khng c mu th vt no ph hp* Virus HIV d b dt bin :- Rt d dng khng thuc. - Khtm duc mt epitope ca tt c cc virus khtm thuc chng nga4THUC TR[ VIRUSNHM CC CHT TNG TU NUCLEOSIDCc thuc nhm ny c cu trc tuong t base pyrimidin v purin Co ch tc dng: can thip vo chui AND ca virus bng cch - Ngn cn s ko di ca chui- Lm mt kh nng thnh Ip diester phosphat vi v tr 5-hydroxyI ca cc nucIeosid.5THUC TR[ VIRUS1/ Nhm cc cht tuong t pyrimidinIdoxuridin (Idurivan)- Tc dng tt trn cc Iai virus thy du, virus bnh zona, virus Heps 1 v 2 (HSV 1 v HSV 2).- Thung duc s dng diu tr vim da do virus,vim kt mac do virus.NNHIOOOHOCH2OH6Trifluridin (Virophta )Iododesoxycytidin(Cuterpes )S dng: vi! s"ng do virusTHUC TR[ VIRUSNNHCF3OOOHOCH2OHNNIONH2OHOCH27THUC TR[ VIRUS2/ Nhm c cu trc tuong t base purin NNNHNONH2CH2OCH2CH2OHAcyclorvir (Zovirax) = AcycloguanosinNNNHNONH2OCH3Ganciclorvir (Cymavan) CH2OHCH2OHHNNNNOOHOCH2Dianosin (!i"x) 2#$3#%i"soxya"nosinNNNNOOHOCH2HOOH&iara'in (!ira % A)(A"nin Ara'inosi)NNNCH2NOCH2OHOHOH&i'avirin (&iva(ol")8THUC TR[ VIRUSNHM CC THUC KHC1/ Amantadin v Rimantadin- Cc thuc ny s dng trong vng 48 gi du sau khi nhim virus gy cm nhm A (infIuenzavirus A). &&= NH2 ) Aman*ain (+an*aix )&= CHCH3NH2&iman*ain (&o,lual )9THUC TR[ VIRUSNHM CC THUC KHC2/ Dn cht phosphorC hoat tnh khng virus Herpes simpIex 1; Zona; Epstein - Barr virus,; CytomegaIovirus v Retro virus ( nhu HIV). HO-COHOHOOFoscarn"* (Foscavir )HO-CH2COOHOHOAci" -.os/.onoac"*ic (Fos,on"*)10THUC TR[ VIRUSNHM CC THUC KHC3/ Human Interferon - L gIycoprotein ca co th ngui sn xut c tc dng khng virus, tng h thng min dch, chng sinh sn. - C 3 Ioai interferon ngui I: , , .- Dang v - interferon duc sn xut cc t bo c trch nhim di vi s nhim virus; vi khun.- Dang - interferon duc sn xut t cc t bo Iympho T- Interferon hin din noi b nhim truc c khi khng th xut hin11THUC TR[ VIRUSNHM CC THUC KHC3/ Human InterferonC# ch$ t%c dng: Cht ny Im vi khun b kt dnh trn b mt ca t bo receptor v ngn cn s xm nhp ca chng.- Interferon -2a (Roferon - A) : ISC- Interferon -2b (Intron - A) : ISC, IMCh& '(nh: - Herps virus - Vim gan B, C124/ OseItamivir phosphatC# ch$ t%c ')ng- L tin cht (dang ethyI ester), trong co th bthy phn v bin thnh dang hoat dng IoseItamivir carboxyIat. - OseItamivir c ch enzym neuraminidase cavirus cm infIuenza nn Im hng phnphng thch ca virus.13THUC TR[ VIRUSNHM CC THUC KHC4/ OseItamivir phosphat*+,c ')ng h-c- Hp thu: qua dung ung, khng nh hung bithc n. - Phn phi: Gn vi protein huyt tuong tt - c th gy tuongtc dy thuc khc ra khi huyt tuong.- Chuyn ha: chuyn ha gan do enzym esterase ca h Cytocrom P450.- Thi tr: ch yu bng dung tiu 14THUC TR[ VIRUSNHM CC THUC KHC4/ OseItamivir phosphatC.ng dng- Tr cm cho bnh nhn t 1 tui tr In (thi gian bnh phi dui 2 ngy).- Phng nga cm cho ngui trn 13 tui.T%c dng ph- Nn ma, nhc du, ho, tiu chy, vim ph qun, dau bng, chng mt, nhc du, mt mi, mt ng (Iiu 75 mg bid). 15S LQC V VIRUS HIV- I virus gy bnh AIDS, duc tm ra nm 183 do Luc Montagnier v cng s (Vin Pasteur Paris) v sau d I nhm khoa hc ca M do Robert GaIIo Inh dao.- y I cc retrovirus thuc nhm Ientivirus (thi gian bnh ko di, gy tn thuong chm dn dn).16S LQC V VIRUS HIVCu Tao Ca Virus HIV17S LQC V VIRUS HIVCu Tao Ca Virus HIV18S LQC V VIRUS HIVCu Tao Ca Virus HIV- V: mng Iipid v 2 gIycoprotein GP 120 v GP 41.- Li: gm protein P15, P18 v P24, hai dy ARN v men reverse transcriptase (RT).- T chc gen ca HIV kh phc tap bao gm gen 19S LQC V VIRUS HIVCc Chu K Sao Chp Ca HIV- HIV dnh vo t bo dch CD4: phn v dnh v Ii xm nhp vo t bo cht.- HIV mt v phng thch ARN- Nh men RT bin ARN thnh AND- AND nhn In thnh provirus (giai doan bnh). Tai dy n nhn di hay bc pht tng hp tr Iai thnh ARN v tng hp protein ca virus- Cc thnh phn ca virus dn mng CD4 v chui ra ngoi thnh HIV t doTm Iai: c s suy gim min dch (gim Iympho CD4)20S LQC V VIRUS HIVTin Iung bnhS bt thung v s Iung CD4 c th dng d chn don v tin Iung bnh.- CD4 500: chua c nguy co, ti khm sau thng- 200 CD4 500: cn kim tra huyt thanh.- CD4 200: c nguy coxut hin nhim trng co hi trong vng 18 thng.- CD4 50: t I t vong rt cao.21CC THUC KHNG HIVNHM THUC C CH MEN RT1/ Cc cht tuong t nhm nucIeosid/idovudin 0 12idothy!idin (1/T3 4etrovir)C# ch$ t%c dng: Dui tc dng ca men thymidinkinase AZT AZT diphosphat AZT triphosphat c ch men RT qua co ch canh tranh vi nucIeosid-5-triphosphat (thymidin).22CC THUC KHNG HIVNHM THUC C CH MEN RT1/ Cc cht tuong t nhm nucIeosid/idovudin 0 12idothy!idin (1/T3 4etrovir )Ch& '(nh: Bnh nhn c Iung CD4 500/mm3 vi triu chng nhim HIV hay nhim khng triu chng s Im gim nguy co tin trin bnh dn giai doan nng trong vng 12 thng.5i6u l+,ng: Thng thung I 00 mg/ngy.23CC THUC KHNG HIVNHM THUC C CH MEN RT1/ Cc cht tuong t nhm nucIeosid/idovudin 0 12idothy!idin (1/T3 4etrovir )7h8n 9ng ph: - Ri Ioan huyt hc v dc trn ty xuong I thung gp nht, phi gim Iiu hay ngng thuc.- Nhc du, i, dau co, mt ng.24CC THUC KHNG HIVNHM THUC C CH MEN RT1/ Cc cht tuong t nhm nucIeosid*idanosin (:3;ivid)Stavudin (/erit)5a!ivudin (?pivir)Sorivudin (@ravavir)26CC THUC KHNG HIVNHM THUC C CH MEN RT2/ Thuc khng phi nucIeosid AevipanrinTI@B (tetrahydroi!ida2o=en2odiaepinon)C%c dCn chDt dipyrinonE27CC THUC KHNG HIVNHM C CH PROTEIN TATProtein Tat I 1 gen can thip vo s sao chp t AND ARN ca retrovirus. Khi c ch men ny, ngha I virus dang ng.Thuc ny khng dng nhu Iiu trnh don dc m thung kt hp vi AZT.Indinavir (Crixivan)4itonadir (Aorvir)SaFuinavirE28CC THUC KHNG HIVTHUC C CH MEN PROTEASE < G