Narrative Review of Anti-Retrovirals Used in COVID-19 Treatment

Authors

DOI:

https://doi.org/10.61740/jcp2s.v3i2.54

Keywords:

COVID-19, anti-retroviral, SARS-CoV-2, RNA-dependent RNA polymerase, antiviral therapy

Abstract

The COVID-19 pandemic has necessitated the exploration of various therapeutic strategies, including the repurposing of existing antiviral drugs. This narrative review examines the use of anti-retroviral agents in the treatment of COVID-19, focusing on their mechanisms of action, efficacy, and safety profiles. Key antiretrovirals discussed include Remdesivir, Lopinavir/Ritonavir, Ribavirin, Oseltamivir, Favipiravir, and Sofosbuvir. These agents primarily act by inhibiting RNA-dependent RNA polymerase (RdRp), a critical enzyme in the replication cycle of SARS-CoV-2. Clinical trials and in vitro studies have provided mixed results regarding their effectiveness, with some agents showing promise in reducing mortality and improving recovery times, while others have demonstrated limited efficacy. The review highlights the urgent need for further clinical research to optimize antiviral regimens and improve patient outcomes in the ongoing battle against COVID-19.

Author Biographies

Aditya Sindu Sakti, Universitas Muhammadiyah Lamongan

Department of Pharmacognosy and Phytochemistry, Faculty of Health Sciences, Universitas Muhammadiyah Lamongan, Lamongan, Indonesia

Irma Susanti, Universitas Muhammadiyah Lamongan

Department of Clinical and Community Pharmacy, Faculty of Health Sciences, Universitas Muhammadiyah Lamongan, Lamongan, Indonesia

Djati Wulan Kusumo, Universitas Muhammadiyah Lamongan

Department of Pharmacognosy and Phytochemistry, Faculty of Health Sciences, Universitas Muhammadiyah Lamongan, Lamongan, Indonesia

References

Abbaspour Kasgari, H., Moradi, S., Shabani, A. M., Babamahmoodi, F., Davoudi Badabi, A. R., Davoudi, L., Alikhani, A., Hedayatizadeh Omran, A., Saeedi, M., Merat, S., Wentzel, H., Garratt, A., Levi, J., Simmons, B., Hill, A., & Tirgar Fakheri, H. (2020). Evaluation of the efficacy of sofosbuvir plus daclatasvir in combination with ribavirin for hospitalized COVID-19 patients with moderate disease compared with standard care: A single-centre, randomized controlled trial. Journal of Antimicrobial Chemotherapy, 75 (11), 3373–3378. https://doi.org/10.1093/jac/dkaa332

Agrawal, U., Raju, R., & Udwadia, Z. F. (2020). Favipiravir: A new and emerging antiviral option in COVID-19. Medical Journal Armed Forces India, 76 (4), 370–376. https://doi.org/10.1016/j.mjafi.2020.08.004

Anand, K., Karade, S., Sen, S., & Gupta, R. (2020). SARS-CoV-2: Camazotz's Curse. Medical Journal Armed Forces India, 76 (2), 136-141.

Baden, L. R., & Rubin, E. J. (2020). Covid-19 — The search for effective therapy. New England Journal of Medicine, 382 (19), 1851–1852. https://doi.org/10.1056/NEJMe2005477

Cai, Q., Yang, M., Liu, D., Chen, J., Shu, D., Xia, J., Liao, X., Gu, Y., Cai, Q., Yang, Y., Shen, C., Li, X., Peng, L., Huang, D., Zhang, J., Zhang, S., Wang, F., Liu, J., Chen, L., ... Liu, L. (2020). Experimental treatment with favipiravir for COVID-19: An open-label control study. Engineering, 6 (10), 1192–1198. https://doi.org/10.1016/j.eng.2020.03.007

Cao, B., Wang, Y., Wen, D., Liu, W., Wang, J., Fan, G., Ruan, L., Song, B., Cai, Y., Wei, M., Li, X., Xia, J., Chen, N., Xiang, J., Yu, T., Bai, T., Xie, X., Zhang, L., Li, C., ... Wang, C. (2020). A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. New England Journal of Medicine, 382 (19), 1787–1799. https://doi.org/10.1056/NEJMoa2001282

Chandawi, A., & Shuter, J. (2008). Lopinavir/ritonavir in the treatment of HIV-1 infection: A review. Therapeutics and Clinical Risk Management, 4 (5), 1023–1033.

Channappanavar, R., Zhao, J., & Perlman, S. (2014). T cell-mediated immune response to respiratory coronaviruses. Immunologic Research, 59n(1–3), 118–128. https://doi.org/10.1007/s12026-014-8534-z

Chen, C., Zhang, Y., Huang, J., Yin, P., Cheng, Z., Wu, J., Chen, S., Zhang, Y., Chen, B., Lu, M., Luo, Y., Ju, L., Zhang, J., & Wang, X. (2020). Favipiravir versus Arbidol for COVID-19: A randomized clinical trial. medRxiv. https://doi.org/10.1101/2020.03.17.20037432

Chien, M., Anderson, T. K., Jockusch, S., Tao, C., Li, X., Kumar, S., Russo, J. J., Kirchdoerfer, R. N., & Ju, J. (2020). Nucleotide analogues as inhibitors of SARS-CoV-2 polymerase, a key drug target for COVID-19. Journal of Proteome Research, 19 (11), 4690–4697. https://doi.org/10.1021/acs.jproteome.0c00392

Choy, K.-T., Wong, A. Y.-L., Kaewpreedee, P., Sia, S. F., Chen, D., Hui, K. P. Y., Chu, D. K. W., Chan, M. C. W., Cheung, P. P.-H., Huang, X., Peiris, M., & Yen, H.-L. (2020). Remdesivir, lopinavir, emetine, and homoharringtonine inhibit SARS-CoV-2 replication in vitro. Antiviral Research, 178, 104786. https://doi.org/10.1016/j.antiviral.2020.104786

Elfiky, A. A. (2020). Ribavirin, remdesivir, sofosbuvir, galidesivir, and tenofovir against SARS-CoV-2 RNA dependent RNA polymerase (RdRp): A molecular docking study. Life Sciences, 248,*117477. https://doi.org/10.1016/j.lfs.2020.117477

Elfiky, A. A. (2020). SARS-CoV-2 RNA dependent RNA polymerase (RdRp) targeting: An in silico perspective. Journal of Biomolecular Structure and Dynamics, 1–9. https://doi.org/10.1080/07391102.2020.1761882

Eslami, G., Mousaviasl, S., Radmanesh, E., Jelvay, S., Bitaraf, S., Simmons, B., Wentzel, H., Hill, A., Sadeghi, A., Freeman, J., Salmanzadeh, S., Esmaeilian, H., Mobarak, M., Tabibi, R., Jafari Kashi, A. H., Lotfi, Z., Talebzadeh, S. M., Wickramatillake, A., Momtazan, M., ... Mobarak, S. (2020). The impact of sofosbuvir/daclatasvir or ribavirin in patients with severe COVID-19. Journal of Antimicrobial Chemotherapy, 75 (11), 3366–3372. https://doi.org/10.1093/jac/dkaa331

Falzarano, D., de Wit, E., Martellaro, C., Callison, J., Munster, V. J., & Feldmann, H. (2013). Inhibition of novel β coronavirus replication by a combination of interferon-α2b and ribavirin. Scientific Reports, 3, 1686. https://doi.org/10.1038/srep01686

Fan, Q., Zhang, B., Ma, J., & Zhang, S. (2020). Safety profile of the antiviral drug remdesivir: An update. Biomedicine & Pharmacotherapy, 130, 110532. https://doi.org/10.1016/j.biopha.2020.110532

Glass, C. A., Cash, J. C., & Mullen, J. (2020). Coronavirus disease (COVID-19). In Family Practice Guidelines. Springer Publishing Company. https://doi.org/10.1891/9780826153425.0016b

Goldman, J. D., Lye, D. C. B., Hui, D. S., Marks, K. M., Bruno, R., Montejano, R., Spinner, C. D., Galli, M., Ahn, M.-Y., Nahass, R. G., Chen, Y.-S., SenGupta, D., Hyland, R. H., Osinusi, A. O., Cao, H., Blair, C., Wei, X., Gaggar, A., Brainard, D. M., & Subramanian, A. (2020). Remdesivir for 5 or 10 days in patients with severe COVID-19. New England Journal of Medicine, 383 (19), 1827–1837. https://doi.org/10.1056/NEJMoa2015301

Gong, J., Dong, H., Xia, S. Q., Huang, Y. Z., Wang, D., Zhao, Y., Liu, W., Tu, S., Zhang, M., Wang, Q., & Lu, F. (2020). Correlation analysis between disease severity and inflammation-related parameters in patients with COVID-19 pneumonia. medRxiv. https://doi.org/10.1101/2020.02.25.20025643

Gordon, C. J., Tchesnokov, E. P., Woolner, E., Perry, J. K., Feng, J. Y., Porter, D. P., & Götte, M. (2020). Remdesivir is a direct-acting antiviral that inhibits RNA-dependent RNA polymerase from severe acute respiratory syndrome coronavirus 2 with high potency. Journal of Biological Chemistry, 295 (20), 6785–6797. https://doi.org/10.1074/jbc.RA120.013679

Hoffmann, G. F., & McKiernan, P. (2017). The single dose pharmacokinetics of ribavirin in subjects with chronic liver disease. In Inherited Metabolic Diseases: A Clinical Approach (pp. 203–226). https://doi.org/10.1007/978-3-662-49410-3_24

Hoffmann, M., Kleine-Weber, H., Schroeder, S., Krüger, N., Herrler, T., Erichsen, S., Schiergens, T. S., Herrler, G., Wu, N.-H., Nitsche, A., Müller, M. A., Drosten, C., & Pöhlmann, S. (2020). SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell, 181 (2), 271-280.e8. https://doi.org/10.1016/j.cell.2020.02.052

Horby, P. W., Mafham, M., Bell, J. L., Linsell, L., Staplin, N., Emberson, J., Palfreeman, A., Raw, J., Elmahi, E., Prudon, B., Green, C., Carley, S., Chadwick, D., Davies, M., Wise, M. P., Baillie, J. K., Chappell, L. C., Faust, S. N., Jaki, T., & Landray, M. J. (2020). Lopinavir–ritonavir in patients admitted to hospital with COVID-19 (Recovery): A randomised, controlled, open-label, platform trial. The Lancet, 396 (10259), 1345–1352. https://doi.org/10.1016/S0140-6736(20)32013-4

Hu, F., Yin, G., Chen, Y., Song, J., Ye, M., Liu, J., Chen, C., Song, Y., Tang, X., & Zhang, Y. (2020). Corticosteroid, oseltamivir and delayed admission are independent risk factors for prolonged viral shedding in patients with coronavirus disease 2019. The Clinical Respiratory Journal, 14 (11), 1067–1075. https://doi.org/10.1111/crj.13243

Huang, Y. Q., Tang, S. Q., Xu, X. L., Zeng, Y. M., He, X. Q., Li, Y., Harypursat, V., Lu, Y. Q., Wan, Y., Zhang, L., Sun, Q. Z., Sun, N. N., Wang, G. X., Yang, Z. P., & Chen, Y. K. (2020). No statistically apparent difference in antiviral effectiveness observed among ribavirin plus interferon-alpha, lopinavir/ritonavir plus interferon-alpha, and ribavirin plus lopinavir/ritonavir plus interferon-alpha in patients with mild to moderate coronavirus infection (COVID-19). Frontiers in Pharmacology. https://doi.org/10.3389/fphar.2020.01071

Hung, I. F. N., Lung, K. C., Tso, E. Y. K., Liu, R., Chung, T. W. H., Chu, M. Y., Ng, Y. Y., Lo, J., Chan, J., Tam, A. R., Shum, H. P., Chan, V., Wu, A. K. L., Sin, K. M., Leung, W. S., Law, W. L., Lung, D. C., Sin, S., Yeung, P., & Yuen, K. Y. (2020). Triple combination of interferon beta-1b, lopinavir–ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: An open-label, randomised, phase 2 trial. The Lancet.*https://doi.org/10.1016/S0140-6736(20)31042-4

Jácome, R., Campillo-Balderas, J. A., Ponce de León, S., Becerra, A., & Lazcano, A. (2020). Sofosbuvir as a potential alternative to treat the SARS-CoV-2 epidemic. Scientific Reports, 10 (1), 9294. https://doi.org/10.1038/s41598-020-66440-9

Jockusch, S., Tao, C., Li, X., Chien, M., Kumar, S., Morozova, I., Kalachikov, S., Russo, J. J., & Ju, J. (2020). Sofosbuvir terminated RNA is more resistant to SARS-CoV-2 proofreader than RNA terminated by remdesivir. Scientific Reports, 10 (1), 16577. https://doi.org/10.1038/s41598-020-73641-9

Kementerian Kesehatan Republik Indonesia. (2020). Situasi COVID-19. https://www.kemkes.go.id

Kim, S. B., Huh, K., Heo, J. Y., Joo, E.-J., Kim, Y. J., Choi, W. S., Kim, Y.-J., Seo, Y. Bin, Yoon, Y. K., Ku, N. S., Jeong, S. J., Kim, S.-H., Peck, K. R., & Yeom, J. S. (2020). Interim guidelines on antiviral therapy for COVID-19. Infection & Chemotherapy, 52 (2), 281. https://doi.org/10.3947/ic.2020.52.2.281

la Porte, C. J. L., Colbers, E. P. H., Bertz, R., Voncken, D. S., Wikstrom, K., Boeree, M. J., Koopmans, P. P., Hekster, Y. A., & Burger, D. M. (2004). Pharmacokinetics of adjusted-dose lopinavir-ritonavir combined with rifampin in healthy volunteers. Antimicrobial Agents and Chemotherapy, 48 (5), 1553–1560. https://doi.org/10.1128/AAC.48.5.1553-1560.2004

Li, F., Lu, J., & Ma, X. (2012). CYP3A4-mediated lopinavir bioactivation and its inhibition by ritonavir. Drug Metabolism and Disposition, 40(1), 18–24. https://doi.org/10.1124/dmd.111.041400

Li, Q., & Kang, C. B. (2020). Progress in developing inhibitors of SARS-CoV-2 3C-like protease. Microorganisms, 8 (8), 1250. https://doi.org/10.3390/microorganisms8081250

Li, W., Moore, M. J., Vasilieva, N., Sui, J., Wong, S. K., Berne, M. A., Somasundaran, M., Sullivan, J. L., Luzuriaga, K., Greenough, T. C., Choe, H., & Farzan, M. (2003). Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature, 426 (6965), 450–454. https://doi.org/10.1038/nature02145

Li, Z., Tomlinson, A. C., Wong, A. H., Zhou, D., Desforges, M., Talbot, P. J., Benlekbir, S., Rubinstein, J. L., & Rini, J. M. (2019). The human coronavirus HCoV-229E S-protein structure and receptor binding. eLife, 8, e51230. https://doi.org/10.7554/eLife.51230

Meini, S., Pagotto, A., Longo, B., Vendramin, I., Pecori, D., & Tascini, C. (2020). Role of lopinavir/ritonavir in the treatment of Covid-19: A review of current evidence, guideline recommendations, and perspectives.Journal of Clinical Medicine, 9 (7), 2050. https://doi.org/10.3390/jcm9072050

Nile, S. H., Nile, A., Qiu, J., Li, L., Jia, X., & Kai, G. (2020). COVID-19: Pathogenesis, cytokine storm and therapeutic potential of interferons. Cytokine & Growth Factor Reviews, 53, 66–70. https://doi.org/10.1016/j.cytogfr.2020.05.002

Qin, C., Zhou, L., Hu, Z., Zhang, S., Yang, S., Tao, Y., Xie, C., Ma, K., Shang, K., Wang, W., & Tian, D.-S. (2020). Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China. Clinical Infectious Diseases, 71 (15), 762–768. https://doi.org/10.1093/cid/ciaa248

Rabi, F. A., Al Zoubi, M. S., Kasasbeh, G. A., Salameh, D. M., & Al-Nasser, A. D. (2020). SARS-CoV-2 and coronavirus disease 2019: What we know so far. Pathogens, 9 (3), 231. https://doi.org/10.3390/pathogens9030231

Rower, J. E., Meissner, E. G., Jimmerson, L. C., Osinusi, A., Sims, Z., Petersen, T., Bushman, L. R., Wolfe, P., McHutchison, J. G., Kottilil, S., & Kiser, J. J. (2015). Serum and cellular ribavirin pharmacokinetic and concentration–effect analysis in HCV patients receiving sofosbuvir plus ribavirin. Journal of Antimicrobial Chemotherapy, 70 (8), 2322–2329. https://doi.org/10.1093/jac/dkv122

Sadeghi, A., Ali Asgari, A., Norouzi, A., Kheiri, Z., Anushirvani, A., Montazeri, M., Hosamirudsai, H., Afhami, S., Akbarpour, E., Aliannejad, R., Radmard, A. R., Davarpanah, A. H., Levi, J., Wentzel, H., Qavi, A., Garratt, A., Simmons, B., Hill, A., & Merat, S. (2020). Sofosbuvir and daclatasvir compared with standard of care in the treatment of patients admitted to hospital with moderate or severe coronavirus infection (COVID-19): A randomized controlled trial. Journal of Antimicrobial Chemotherapy, 75 (11), 3379–3385. https://doi.org/10.1093/jac/dkaa334

Sayad, B., Sobhani, M., & Khodarahmi, R. (2020). Sofosbuvir as repurposed antiviral drug against COVID-19: Why were we convinced to evaluate the drug in a registered/approved clinical trial? Archives of Medical Research, 51 (6), 577–581. https://doi.org/10.1016/j.arcmed.2020.04.018

Setiadi, A. P., Wibowo, Y. I., Halim, S. V., Brata, C., Presley, B., & Setiawan, E. (2020). Tata laksana terapi pasien dengan COVID-19: Sebuah kajian naratif. Indonesian Journal of Clinical Pharmacy, 9 (1), 70. https://doi.org/10.15416/ijcp.2020.9.1.70

Sigrist, C. J., Bridge, A., & Le Mercier, P. (2020). A potential role for integrins in host cell entry by SARS-CoV-2. Antiviral Research, 177, 104759. https://doi.org/10.1016/j.antiviral.2020.104759

Spinner, C. D., Gottlieb, R. L., Criner, G. J., Arribas López, J. R., Cattelan, A. M., Soriano Viladomiu, A., Ogbuagu, O., Malhotra, P., Mullane, K. M., Castagna, A., Chai, L. Y. A., Roestenberg, M., Tsang, O. T. Y., Bernasconi, E., Le Turnier, P., Chang, S. C., Sengupta, D., Hyland, R. H., Osinusi, A. O., & Marty, F. M. (2020). Effect of remdesivir vs standard care on clinical status at 11 days in patients with moderate COVID-19: A randomized clinical trial. JAMA, 324 (11), 1048–1057. https://doi.org/10.1001/jama.2020.16349

Sugitha, K. S. L. (2020). COVID-19: Respon imunologis, ketahanan pada permukaan benda dan pilihan terapi klinis. Intisari Sains Medis, 11 (2), 791–797. https://doi.org/10.15562/ism.v11i2.746

Sun, D. (2020). Remdesivir for treatment of COVID-19: Combination of pulmonary and IV administration may offer additional benefit. *AAPS Journal, 22 (4), 77. https://doi.org/10.1208/s12248-020-00459-8

Tan, Q., Duan, L., Ma, Y., Wu, F., Huang, Q., Mao, K., Xiao, W., Xia, H., Zhang, S., Zhou, E., Ma, P., Song, S., Li, Y., Zhao, Z., Sun, Y., Li, Z., Geng, W., Yin, Z., & Jin, Y. (2020). Is oseltamivir suitable for fighting against COVID-19: In silico assessment, in vitro and retrospective study. Bioorganic Chemistry, 104, 104257. https://doi.org/10.1016/j.bioorg.2020.104257

Tong, S., Su, Y., Yu, Y., Wu, C., Chen, J., Wang, S., & Jiang, J. (2020). Ribavirin therapy for severe COVID-19: A retrospective cohort study. International Journal of Antimicrobial Agents, 56 (3), 106114. https://doi.org/10.1016/j.ijantimicag.2020.106114

Ulhaq, Z. S., & Soraya, G. V. (2020). Interleukin-6 as a potential biomarker of COVID-19 progression. Médecine et Maladies Infectieuses, 50 (4), 382–383. https://doi.org/10.1016/j.medmal.2020.04.002

Uzunova, K., Filipova, E., Pavlova, V., & Vekov, T. (2020). Insights into antiviral mechanisms of remdesivir, lopinavir/ritonavir and chloroquine/hydroxychloroquine affecting the new SARS-CoV-2. Biomedicine & Pharmacotherapy, 131, 110668. https://doi.org/10.1016/j.biopha.2020.110668

Vaduganathan, M., Vardeny, O., Michel, T., McMurray, J. J. V., Pfeffer, M. A., & Solomon, S. D. (2020). Renin–angiotensin–aldosterone system inhibitors in patients with COVID-19. New England Journal of Medicine, 382 (17), 1653–1659. https://doi.org/10.1056/NEJMsr2005760

Wang, M., Cao, R., Zhang, L., Yang, X., Liu, J., Xu, M., Shi, Z., Hu, Z., Zhong, W., & Xiao, G. (2020). Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Research, 30 (3), 269–271. https://doi.org/10.1038/s41422-020-0282-0

Wang, Q., Zhang, Y., Wu, L., Niu, S., Song, C., Zhang, Z., Lu, G., Qiao, C., Hu, Y., Yuen, K.-Y., Wang, Q., Zhou, H., Yan, J., & Qi, J. (2020). Structural and functional basis of SARS-CoV-2 entry by using human ACE2. Cell, 181 (4), 894-904.e9. https://doi.org/10.1016/j.cell.2020.03.045

Wang, Y., Anirudhan, V., Du, R., Cui, Q., & Rong, L. (2020). Recent updates in the pharmacological management of COVID-19. Letters in Applied NanoBioScience, 10 (1), 1969-1980.

Wang, Y., Zhang, D., Du, G., Du, R., Zhao, J., Jin, Y., Fu, S., Gao, L., Cheng, Z., Lu, Q., Hu, Y., Luo, G., Wang, K., Lu, Y., Li, H., Wang, S., Ruan, S., Yang, C., Mei, C., ... Wang, C. (2020). Remdesivir in adults with severe COVID-19: A randomised, double-blind, placebo-controlled, multicentre trial. The Lancet, 395(10236), 1569–1578. https://doi.org/10.1016/S0140-6736(20)31022-9

Wiersinga, W. J., Rhodes, A., Cheng, A. C., Peacock, S. J., & Prescott, H. C. (2020). Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19). JAMA, 324 (8), 782. https://doi.org/10.1001/jama.2020.12839

World Health Organization. (2020). Coronavirus disease (COVID-19) pandemic. https://www.who.int/emergencies/diseases/novel-coronavirus-2019

Wu, C. Y., Jan, J. T., Ma, S. H., Kuo, C. J., Juan, H. F., Cheng, Y. S. E., Hsu, H. H., Huang, H. C., Wu, D., Brik, A., Liang, F. S., Liu, R. S., Fang, J. M., Chen, S. T., Liang, P. H., & Wong, C. H. (2004). Small molecules targeting severe acute respiratory syndrome human coronavirus. Proceedings of the National Academy of Sciences of the United States of America. https://doi.org/10.1073/pnas.0403596101

Wu, C., Chen, X., Cai, Y., Xia, J., Zhou, X., Xu, S., Huang, H., Zhang, L., Zhou, X., Du, C., Zhang, Y., Song, J., Wang, S., Chao, Y., Yang, Z., Xu, J., Zhou, X., Chen, D., Xiong, W., ... Song, Y. (2020). Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Internal Medicine, 180 (7), 934. https://doi.org/10.1001/jamainternmed.2020.0994

Wu, Z., & McGoogan, J. M. (2020). Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China. JAMA, 323 (13), 1239. https://doi.org/10.1001/jama.2020.2648

Xu, Z., Shi, L., Wang, Y., Zhang, J., Huang, L., Zhang, C., Liu, S., Zhao, P., Liu, H., Zhu, L., Tai, Y., Bai, C., Gao, T., Song, J., Xia, P., Dong, J., Zhao, J., & Wang, F.-S. (2020). Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet Respiratory Medicine, 8 (4), 420–422. https://doi.org/10.1016/S2213-2600(20)30076-X

Yuki, K., Fujiogi, M., & Koutsogiannaki, S. (2020). COVID-19 pathophysiology: A review. Clinical Immunology, 215, 108427. https://doi.org/10.1016/j.clim.2020.108427

Zhou, Y., Fu, B., Zheng, X., Wang, D., Zhao, C., Qi, Y., Sun, R., Tian, Z., Xu, X., & Wei, H. (2020). Pathogenic T-cells and inflammatory monocytes incite inflammatory storms in severe COVID-19 patients. National Science Review, 7 (6), 998–1002. https://doi.org/10.1093/nsr/nwaa041

Zou, X., Chen, K., Zou, J., Han, P., Hao, J., & Han, Z. (2020). Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Frontiers of Medicine, 14 (2), 185–192. https://doi.org/10.1007/s11684-020-0754-0

Published

2024-10-24

How to Cite

Aditya Sindu Sakti, Irma Susanti, & Djati Wulan Kusumo. (2024). Narrative Review of Anti-Retrovirals Used in COVID-19 Treatment. Journal Clinical Pharmacy and Pharmaceutical Science, 3(2), 36–54. https://doi.org/10.61740/jcp2s.v3i2.54