Anti-HIV Drugs for Coronavirus: Could They Be Effective?
In a few cases across the world, antiviral drugs have seemed to work against the novel coronavirus.
As the world grapples with the rapid spread of the new strain of coronavirus, the medical and scientific fraternity is working laboriously to find viable ways to treat the thousands of people affected by it.
Efforts to develop a vaccine are ongoing, but a new vaccine will probably take months, or even years to come into actual use — as our past experiences with Ebola and Zika have shown.
The first Ebola vaccine, for instance, emerged after almost 20 years of research and four years of clinical testing, while for Zika or SARS (2003), tests are still underway.
As the death toll from COVID-19 increases sporadically, parallel efforts are on to look for interim (and hopefully permanent) solutions for faster improvement in patients. In a few cases across the world, antiviral drugs have seemed to work.
‘Cocktail’ of Drugs Used to Treat Patients
The Italian couple that had tested positive for COVID-19 in Jaipur, is the first one in India to be administered anti-HIV drugs for the treatment of the novel coronavirus.
According to an article in The New Indian Express, the woman has tested negative for the infection in the past 24 hours, and her husband has also shown ‘low viral load’.
The Drug Controller General of India (DCGI) had earlier consented to the ‘restricted use’ of a combination of anti-HIV drugs for treating those affected by 2019-nCoV, after the Indian Council of Medical Research had sought an emergency approval for the use of the two drugs — ‘lopinavir’ and ‘ritonavir’.
According to a Reuters report, doctors from Rajavithi Hospital in Bangkok have successfully treated severe cases of the virus using a combination of drugs for flu and HIV. In fact, a 70-year-old Chinese woman from Wuhan, who had tested positive initially, showed improvement within two days. Dr. Kriangska Atipornwanich, a lung specialist at Rajavithi, told reporters,
“This is not the cure, but the patient’s condition has vastly improved. From testing positive for 10 days under our care, after applying this combination of medicine the test result became negative within 48 hours.”Dr. Kriangska Atipornwanich
The combination includes a mixture of anti-HIV drugs lopinavir and ritonavir, along with the flu drug oseltamivir in large doses.
Even Chinese health authorities have been administering these drugs, while maintaining that there is no effective cure for the virus yet.
Another antiviral drug, called remdesivir, which had initially been developed to fight Ebola, was used to treat the first patient affected by the Wuhan coronavirus in the US. IANS reports that the Wuhan Institute of Virology has applied for a patent in China for the use of this antiviral therapy.
The Indian pharmaceutical major Cipla, is also reportedly keeping a stock ready of the two anti-HIV drugs. Chairman Yusuf Khwaja Hamied said that these medicines are off-patent and are now being repurposed to deal with the new virus. “We are now approaching the Indian government that in case of any emergency, we will rise to the occasion and help,” a Business Today report quotes him as saying.
“I have already got a phone call from our partners in China who wanted to know if we would be in the position to supply the medicines if necessary.”Yusuf Khwaja Hamied
However, in all the cases where improvement has been observed in patients, researchers have asserted the need to hold randomized control studies to be sure of the safety and efficacy of these medicines.
In fact, one of the patients in Thailand showed an allergic reaction to the drug cocktail, raising doubts for any universal application.
Indian Experts Weigh In: Are These Drugs Reliable?
FIT spoke to Dr Naga Suresh Veerapu, a virologist and assistant professor at Shiv Nadar University, who said that it is difficult to believe that antiviral drugs could be effective in all cases. SARS was a similar strain, and there is no treatment modality for it yet.
“I will not rule out the possibility, but I am doubtful it could be an absolute treatment.”Dr Naga Suresh Veerapu
However, until a vaccine is developed, which could take at least a year, testing antivirals could be a quicker alternative, he adds.
Highlighting the need for a clinical trial, Dr Samit Bhattacharyya, head of the Disease Modeling Laboratory at Shiv Nadar University, said,
“So far, we have only seen a few cases where antivirals worked. Those could be patient-specific. Unless there is a proper trial, we can’t make any statements.”Dr Samit Bhattacharyya
When asked about the current methods of treatment being used on patients affected by the novel coronavirus, both experts agree that there is no clarity yet. Doctors around the world are trying all sorts of treatment combinations. They could be choosing among antiviral options available in the repository to see what works. “There must be a trial and error approach. The current combination of drugs working on a few patients is not surprising,” Dr Veerapu said.
Dr Bhattacharyya also raises an important question.
“We are not sure at this stage whether these drugs are stopping or subsiding the symptoms, or actually blocking the virus. These are two separate things. The patients may just be getting relief from the symptoms, but the virus still may be replicating within the body.”Dr Samit Bhattacharyya
But how does this explain the DCGI approval for the restricted use of these drugs?
Dr Veerapu says that the idea behind approving these drugs is that they have already been tested for previous illnesses. So we know they are safe, and if they work against the new strain, it would be great. ‘Repurposing’ the drugs, as this is called, could be the fastest possible solution to the epidemic.
The only way forward, therefore, is clinical testing of these drugs. Efforts in this direction are already underway, with China testing an HIV medicine called Aluvia (a fixed-dose combination of lopinavir/ritonavir) as a treatment option, reports suggest.
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