Table 1 Summary of the main molecular trade-off mechanisms favoring transmissibility/latency over virulence
Main molecular mechanism | Less virulent strain | Drugs under trial | More virulent strain | References in text | |
|---|---|---|---|---|---|
Acute infections: Virulence trade-off theory | |||||
Influenza | Mutations in HA favoring non-alveolar cell tropism by differential sialic acid tropism | Seasonal human influenza strains | Umifenovir inhibits viral attachment to sialic acid | Avian influenza strain H5N1 | Popov et al. (2021) |
COVID-19 | Mutations in spike protein promoting endocytic rather than TMPRSS2 mediated entry impeding lower respiratory tract infection | Omicron variant | TMPRSS2 inhibitors such as CAMOSTAT | Delta variant | Shapira (2022) |
Chronic infections: Invasion–persistence theory | |||||
HIV | Promoted sensitivity to CD4 mediated fusion into latent cellular reservoirs thus escaping retroviral therapy | M-tropic viruses | BIT225 PI3K/AKT inhibitors | R5 T-tropic viruses | Pasquereau and Herbein (2022) |
Malaria | Mutations in PfK13 allows survival | Artemisinin- resistant Plasmodium falciparum strains | Targeting cyclin dependent kinases in Malaria to overcome drug resistance and dormancy | Non artemisinin resistant Plasmodium falciparum strains | Balestra et al. (2020) |
HBV | Mutations in pre-S/S region promoting vaccine failure, immune escape, occult HBV infection and generation of HCC | Mutated HBV strains | Checkpoint inhibitors and therapeutic vaccines to overcome immune escapism of the new variants of HBV | Wild-type HBV | Hoogeveen and Boonstra (2020) |
Mutations in the P region encoding for RT promoting drug resistance to NA antivirals | |||||
Mutations in pre-C/C region prompting HBeAg negativity via termination of its translation, immune escape and HBV persistence | |||||
Tuberculosis | DoSr upregulation allowing survival in prolonged hypoxia | L1, L2 & L3 lineages | The carbonic anhydrase inhibitor ethoxzolamide | L4 lineage | |