acyclovir and Anemia--Sickle-Cell

To assess safety and tolerability, we administered valacyclovir, an oral anti-viral medication that inhibits erythrocyte sickling in vitro, to 14 subjects with sickle-cell anemia for 1 week at a standard dose of 1,000 mg every 8 hr. No clinically significant adverse effects occurred. In 11 subjects in steady state, the mean hemoglobin concentration was almost constant while the absolute reticulocyte count decreased in eight (P = 0.1) and the overall mean fell slightly although not significantly (10%, P = 0.2). These results suggest that valacyclovir is safe and well tolerated in patients with sickle-cell anemia and that a longer duration of therapy merits investigation.

Topics: Acyclovir; Adolescent; Adult; Anemia, Sickle Cell; Antisickling Agents; Antiviral Agents; Erythrocytes, Abnormal; Female; Hemoglobins; Humans; Male; Maximum Tolerated Dose; Prodrugs; Prospective Studies; Safety; Survival Rate; Treatment Outcome; Valacyclovir; Valine; Young Adult

Stroke is the most common neurologic complication of sickle cell disease. Acute chest syndrome (ACS) is a known risk factor for stroke in this population. Two patients (a 12-year-old boy and a 6-year-old girl) developed acute change of mental status and focal neurologic signs during episodes of ACS. The clinical and radiologic findings were compatible with acute necrotizing encephalitis, a variant of acute demyelinating encephalomyelitis. Patients with acute neurologic deterioration in conjunction with ACS should be evaluated thoroughly for other causes of central nervous system disease including infectious/parainfectious processes as well as stroke.

Topics: Acyclovir; Anemia, Sickle Cell; Brain; Child; Doxycycline; Encephalomyelitis; Erythrocyte Transfusion; Female; Humans; Magnetic Resonance Imaging; Male; Pneumonia, Mycoplasma; Syndrome; Tomography, X-Ray Computed; Vancomycin