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Predicted success of prophylactic antiviral therapy to block or delay SARS-CoV-2 infection depends on the drug's mechanism of action

Journal Article · · PLoS Computational Biology (Online)
 [1];  [2];  [3];  [3];  [4];  [3];  [5]
  1. Sorbonne Univ., Paris (France). Inst. of Ecology and Environmental Sciences of Paris; PSL Research Univ., Paris (France). Center for Interdisciplinary Research in Biology
  2. Sorbonne Univ., Paris (France). Inst. of Ecology and Environmental Sciences of Paris
  3. Univ. of Paris (France). INSERM, IAME
  4. Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Los Alamos National Lab. (LANL), Los Alamos, NM (United States). New Mexico Consortium
  5. PSL Research Univ., Paris (France). Center for Interdisciplinary Research in Biology; Univ. of Paris (France). INSERM, IAME
Repurposed drugs that are safe and immediately available constitute a first line of defense against new viral infections. Despite limited antiviral activity against SARS-CoV-2, several drugs are being tested as medication or as prophylaxis to prevent infection. Using a stochastic model of early phase infection, we evaluate the success of prophylactic treatment with different drug types to prevent viral infection. We find that there exists a critical efficacy that a treatment must reach in order to block viral establishment. Treatment by a combination of drugs reduces the critical efficacy, most effectively by the combination of a drug blocking viral entry into cells and a drug increasing viral clearance. Below the critical efficacy, the risk of infection can nonetheless be reduced. Drugs blocking viral entry into cells or enhancing viral clearance reduce the risk of infection more than drugs that reduce viral production in infected cells. The larger the initial inoculum of infectious virus, the less likely is prevention of an infection. In our model, we find that as long as the viral inoculum is smaller than 10 infectious virus particles, viral infection can be prevented almost certainly with drugs of 90% efficacy (or more). Even when a viral infection cannot be prevented, antivirals delay the time to detectable viral loads. The largest delay of viral infection is achieved by drugs reducing viral production in infected cells. A delay of virus infection flattens the within-host viral dynamic curve, possibly reducing transmission and symptom severity. Thus, antiviral prophylaxis, even with reduced efficacy, could be efficiently used to prevent or alleviate infection in people at high risk.
Research Organization:
Los Alamos National Laboratory (LANL), Los Alamos, NM (United States)
Sponsoring Organization:
USDOE Laboratory Directed Research and Development (LDRD) Program
Grant/Contract Number:
89233218CNA000001
OSTI ID:
1774443
Report Number(s):
LA-UR--20-23569
Journal Information:
PLoS Computational Biology (Online), Journal Name: PLoS Computational Biology (Online) Journal Issue: 3 Vol. 17; ISSN 1553-7358
Publisher:
Public Library of ScienceCopyright Statement
Country of Publication:
United States
Language:
English

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