Table 2: Antiviral therapies for human polyomavirus infection.

Antiviral agentMechanism of action HPyVIn vitro
Clinical syndromeStudy designPatient groupClinical benefitReferences

Cytosine arabinoside
Nucleoside analogue
(DNA polymerase inhibitor)
JCVYesPMLCase series/reportsHIV, non-HIV, dermatomyositisYes[282285]
PMLCase series/reportsHIV, non-HIV, dermatomyositisNo[282, 286289]

PMLPilot studyHIVNo[281]
JCVNoPMLMulticohort analysisHIVNo[279]
PMLMulticentre Retrospective analysisHIVNo[278]
Nucleotide phosphonate analogue (DNA polymerase inhibitor)PMLCase seriesHIVNo[280]
PMLCase reportsHIV, the Heerfordt syndrome, SLEYes[275277]
BKVYesHCCase seriesHSCTYes[292]
BKVNNonrandomised Controlled study (low-dose CDV)Renal T’plantYes[293]
TSVN/ATSCase reportHeart T’plant, CLLYes[6, 294]

JCVYes[295, 296]
PMLCase reportIdiopathic CD4+ lymphocytopaeniaYes[297]
CMX001Lipid conjugate of Cidofovir
BK ViruriaRCTRenal T’

[298, 299]
PMLCase report (mirtazapine)DermatomyositisYes[285]
Serotonin receptor 2A (5HT2AR) antagonistsInhibits JCV receptor binding and cell entryJCVYesPMLCase report
PMLCase report

MefloquineUnknown: may directly inhibit large T antigenJCVYes[302]
PMLCase reportSarcoidosis, AML/UBCTYes[303, 304]

LeflunomideInhibits pyrimidine synthesis; inhibits tyrosine kinaseBKVYes [305, 306]
BKVNCase seriesRenal T’plantYes[307]
BKVNCase seriesRenal T’plantNo[308]
BKVNCase seriesRenal T’plantNo[309]

FK778Derived from the active metabolite of LeflunomideBKVNRCTRenal T’plantNo[310]

Fluoroquinolones Inhibit large T antigen helicase activity BKV Yes[311, 312]
BK viraemiaCase seriesRenal T’plantYes[313]
Renal T’plantYes
(3 mo.)
(12 mo.)
HCCase seriesHSCTYes[315]

Mammalian target of rapamycin (mTOR) inhibitors Reduce translation and
cell cycle progression
BKV Yes (sirolimus)[316]
BKVN Case seriesRenal T’plantYes[317]
BKVNCase reportRenal T’plantNo[199]
BK viraemiaProspective Nonrandomised controlled studyRenal T’plant (Paediatric)No[318]

This table lists the available therapeutic options for human polyomavirus infections. KIPyV, WUPyV, HPyV6, 7, 9, and 10 have not been included as there are presently no definitive disease associations for these viruses. Abbreviations are defined in the accompanying text.