acyclovir and Atrophy

Prevention of cytomegalovirus (CMV) is essential in organ transplantation. The two main strategies are pre-emptive therapy, in which one screens for and treats asymptomatic CMV viremia, and universal antiviral prophylaxis. We compared these strategies and examined long-term outcomes in a randomized, open-label, single-center trial. We randomly assigned 70 renal transplant recipients (CMV-seropositive recipient or donor) to 3-month prophylaxis with valacyclovir (n=34) or pre-emptive valganciclovir for significant CMV viremia detected at predefined assessments through month 12 (n=36). Among the 55 patients who had a protocol biopsy specimen available at 3 years to allow assessment of the primary outcome, 9 (38%) of 24 patients in the prophylaxis group and 6 (19%) of 31 patients in the pre-emptive therapy group had moderate to severe interstitial fibrosis and tubular atrophy (odds ratio, 2.50; 95% confidence interval, 0.74-8.43; P=0.22). The prophylaxis group had significantly higher intrarenal mRNA expression of genes involved in fibrogenesis. The occurrence of CMV disease was similar in both groups, but pre-emptive therapy improved 4-year graft survival (92% versus 74%; P=0.049) as a result of worse outcomes in patients with late-onset CMV viremia. In conclusion, compared with valacyclovir prophylaxis, pre-emptive valganciclovir therapy may lead to less severe interstitial fibrosis and tubular atrophy and to significantly better graft survival.

Topics: Acyclovir; Adult; Antiviral Agents; Atrophy; Biopsy; Cytomegalovirus; Cytomegalovirus Infections; Female; Fibrosis; Follow-Up Studies; Ganciclovir; Graft Survival; Humans; Kaplan-Meier Estimate; Kidney; Kidney Transplantation; Longitudinal Studies; Male; Middle Aged; Treatment Outcome; Valacyclovir; Valganciclovir; Valine

We examined the recurrence rate of herpetic uveitis (HU) in 13 patients (group A) treated prophylactically with long-term systemic acyclovir (600-800 mg/day) and compared it with that of 7 patients with no prophylactic therapy (group B). HU was diagnosed on the basis of a history of dendritic or disciform keratitis accompanied by iridocyclitis and iris atrophy. The study population consisted of 12 men and 8 women with a mean age at onset of uveitis of 52.9 years (range 19-78 years). All patients were followed for at least 8 months. The mean follow-up time of patients on long-term oral acyclovir was 26.0 months. In this group, only one patient experienced a single recurrent episode of uveitis while on 600-800 mg/day of acyclovir therapy; two additional patients had recurrence of HU within 16.2 months after the acyclovir dose was tapered below 600 mg/day. In striking contrast, 16 recurrences occurred in the 7 patients of group B (p < 0.05). Of these, the initial recurrence occurred within an average of 4.3 months following cessation of therapy. There was a significant difference (p < 0.05) in the mean recurrence-free interval between patients in group A (24.6 months) and those in group B (3.4 months). Herpetic uveitis is a serious ocular disease in which recurrence of inflammation results in severe ocular complications. The long-term use of oral acyclovir may be of benefit in the prevention of recurrences, and hence may reduce the blinding complications of this disease. Efforts at completing a randomized, placebo-controlled trial on this matter by the Herpes Epithelial Disease Study Group were unsuccessful due to insufficient patient recruitment.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Administration, Oral; Adult; Aged; Antiviral Agents; Atrophy; Female; Humans; Iridocyclitis; Iris; Keratitis, Dendritic; Keratitis, Herpetic; Male; Middle Aged; Recurrence; Treatment Outcome; Uveitis; Visual Acuity

Topics: Acyclovir; Administration, Ophthalmic; Antibodies, Viral; Antiviral Agents; Atrophy; Child; Enzyme-Linked Immunosorbent Assay; Eye Infections, Viral; Female; Glucocorticoids; Humans; Immunoglobulin G; Infusions, Intravenous; Intraocular Pressure; Mumps; Mumps virus; Prednisolone; Retinal Necrosis Syndrome, Acute; Retinal Pigment Epithelium; Tomography, Optical Coherence; Visual Acuity

Topics: Acyclovir; Anti-Bacterial Agents; Anti-HIV Agents; Antiviral Agents; Atrophy; Basal Ganglia; Brain; Calcinosis; Child; Drug Therapy, Combination; Epstein-Barr Virus Infections; Female; HIV Infections; Humans; Magnetic Resonance Imaging; Meningoencephalitis; White Matter

The significance of detecting herpes simplex virus (HSV) DNA in the cerebrospinal fluid (CSF) of infants with HSV encephalitis after receipt of prolonged therapy with high-dose (60 mg kg(-1) day(-1)) acyclovir is unknown. We report the clinical and laboratory characteristics, neuroimaging studies and outcomes of four neonates with HSV encephalitis who had persistence of CSF HSV DNA, by polymerase chain reaction (PCR) after 15 to 21 days of high-dose acyclovir therapy.. Retrospective chart review.. All four infants had abnormal neuroimaging studies and subsequently experienced severe developmental delay or death.. A persistently positive CSF HSV PCR in neonates may be another risk factor for worse neurodevelopmental outcome. Prospective studies are needed to document how often HSV DNA persists in CSF, elucidate whether it represents an initially high CSF viral load, ongoing viral replication or viral resistance, and determine its possible association with neurodevelopmental impairment.

Topics: Acyclovir; Adult; Antiviral Agents; Atrophy; Brain; Brain Damage, Chronic; DNA, Viral; Dose-Response Relationship, Drug; Drug Administration Schedule; Encephalitis, Herpes Simplex; Encephalomalacia; Female; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Male; Polymerase Chain Reaction; Pregnancy; Prognosis; Retrospective Studies; Simplexvirus; Tomography, X-Ray Computed; Viral Load

Scleromalacia usually appears following vasculitis in systemic rheumatoid diseases, especially as a late symptom of rheumatoid arthritis.. A 67-year-old woman was referred to our hospital for further evaluation with the diagnosis of a "fast-growing tumor" of the left eye. Sixteen months ago she had suffered from herpes zoster ophthalmicus-associated keratouveitis and trabeculitis in the same eye. Scleromalacia associated with varicella-zoster virus (VZV) was diagnosed after the biomicroscopic and gonioscopic examination of the eye was completed and a systemic disease had been ruled out. One week after beginning systemic application of acyclovir (5 x 800 mg daily) and prednisolone (30 mg daily), the anterior chamber inflammation regressed and a fibrosis seemed to appear in the atrophic scleral area.. Although scleral atrophy mostly appears as a late sign of systemic rheumatoid diseases, it might also develop secondary to infectious diseases. Scleromalacia associated with varicella-zoster virus has been previously described only in a few cases. Scleromalacia is a vision-threatening complication of zoster ophthalmicus which responds well to combination therapy with systemic antiviral and anti-inflammatory agents.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Aged; Anti-Inflammatory Agents; Antiviral Agents; Atrophy; Drug Therapy, Combination; Eye Hemorrhage; Female; Fibrosis; Fundus Oculi; Herpes Zoster Ophthalmicus; Humans; Long-Term Care; Ophthalmoscopy; Prednisolone; Recurrence; Sclera; Scleral Diseases; Uveitis, Anterior

To report a case of zoster sine herpete with bilateral ocular involvement.. Case report.. A 65-year-old man showed bilateral iridocyclitis with sectoral iris atrophy and elevated intraocular pressure unresponsive to steroid treatment. No cutaneous eruption was manifest on the forehead. A target region of varicella-zoster virus DNA sequence was amplified from the aqueous sample from the left eye by polymerase chain reaction. Bilateral iridocyclitis resolved promptly after initiation of systemic and topical acyclovir treatment. Secondary glaucoma was well controlled by bilateral trabeculectomy.. Zoster sine herpete should be considered and polymerase chain reaction performed on an aqueous sample to detect varicella-zoster virus DNA for rapid diagnosis whenever anterior uveitis accompanies the characteristic iris atrophy, even in the case of bilateral involvement.

Topics: Acyclovir; Aged; Antiviral Agents; Atrophy; DNA Primers; DNA, Viral; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Intraocular Pressure; Iridocyclitis; Iris; Male; Ocular Hypertension; Polymerase Chain Reaction; Trabeculectomy; Visual Acuity

We examined an immunocompetent patient with uniocular acute progressive outer retinitis. The retinitis was curvilinear in shape, showed progressive enlargement, and appeared to be altered by treatment with intravenous acyclovir. When regressed, the affected area of retina appeared atrophic and, at one-year follow-up, demonstrated intraretinal pigment migration with retinal pigment epithelial atrophy and atrophy of the choriocapillaris. Although visual acuity was unaffected, a dense scotoma was recorded on field testing. The response to acyclovir implicates the herpesvirus family, and acyclovir or another antiherpetic agent should be considered for such cases.

Topics: Acyclovir; Adult; Atrophy; Female; Humans; Immunocompetence; Recurrence; Retinitis