acyclovir and Leukoplakia--Oral

Current data about oral hairy leukoplakia are reported. Clinical manifestations, histological and ultrastructural features and pathogenic mechanisms are firstly described. Then diagnosis are exposed. Finally, management is discussed.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Herpesvirus 4, Human; Humans; Leukoplakia, Oral; Male; Tongue Diseases

The efficacy of desciclovir, an analog of acyclovir, in eliminating lesions of oral hairy leukoplakia (HL) and suppressing Epstein-Barr virus (EBV) infection was evaluated in a double-blind, placebo-controlled study of 14 patients. Patients were randomized to receive either the active drug, 250 mg three times a day for 14 days, or placebo. In all eight patients receiving desciclovir, lesions of HL were either completely resolved or significantly reduced during the treatment period, whereas lesions in patients receiving placebo showed no change. The histological features of HL were significantly diminished in patients on desciclovir, and cytochemical, in situ hybridization, and ultrastructural studies showed that EBV infection was eliminated or dramatically reduced in the desciclovir group only. Four patients on desciclovir reported side effects, but none required withdrawal from the study. The reappearance of HL in all eight subjects on desciclovir within 1-4 months after therapy was discontinued suggests the need for additional study.

Topics: Acyclovir; Adult; Antigens, Viral; Antiviral Agents; DNA, Viral; Double-Blind Method; Herpesvirus 4, Human; Humans; Immunohistochemistry; Leukoplakia, Oral; Male; Randomized Controlled Trials as Topic; Serologic Tests; Tumor Virus Infections

Topics: Acyclovir; Adult; Biopsy; Female; HIV Infections; HIV Seropositivity; Humans; Leukoplakia, Oral

The therapy of choice for oral hairy leucoplakia in HIV-infected patients is treatment with acyclovir. During treatment the replication of Epstein-Barr Virus (EBV) in cells scraped from the epithelium of hairy leucoplakia was investigated using filter-in-situ hybridization. On the 2nd day of treatment a slight and on the 5th day a marked reduction of the replication was observed, and on the 8th day of treatment replication of EBV could hardly be detected. At that time a marked regression of leucoplakia was seen. Within another 7 days the lesions had completely disappeared. These findings demonstrate the relationship between treatment with acyclovir and inhibition of EBV replication in hairy leucoplakia and the relationship between inhibition of EBV replication and remission of hairy leucoplakia.

Topics: Acyclovir; Herpesvirus 4, Human; HIV Infections; Humans; Leukoplakia, Oral; Male; Middle Aged; Virus Replication

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Drug Therapy, Combination; HIV-1; Humans; Leukoplakia, Oral; Zidovudine

To compare the therapeutic effects of surgical excision and orally administered acyclovir therapy on symptomatic oral hairy leukoplakia, 45 homosexual men who were seropositive for human immunodeficiency virus participated in a 3-month open-label study. In the 14 patients who had surgical excision, pain resolved in four symptomatic patients and the leukoplakia did not recur in the areas of excision. New foci of leukoplakia, however, appeared in 10 patients after 3 months. Of the 16 patients who received acyclovir therapy, 12 had a clinical regression, although recurrences were noted in all patients after 3 months. Three patients had resolution of pain while taking acyclovir; in two the pain recurred after acyclovir was discontinued. No spontaneous remissions of the leukoplakia occurred in the 15 patients who refused therapy. We conclude that surgical excision is effective in patients with symptomatic oral hairy leukoplakia.

Topics: Acyclovir; Administration, Oral; HIV Seropositivity; Humans; Hybridization, Genetic; Leukoplakia, Oral; Male

To define the role of Epstein-Barr virus (EBV) in the pathogenesis of oral hairy leukoplakia, 13 human immunodeficiency virus-seropositive men with clinical and histologic evidence of oral hairy leukoplakia were enrolled in an open-label trial of orally administered acyclovir therapy (3.2 g/d for 20 days). Of six patients who received therapy, five exhibited clinical regression. Once therapy was discontinued, recurrences occurred in all responders. Among seven patients who refused therapy, no spontaneous remissions occurred. Before therapy, EBV replication within the leukoplakia was demonstrated by immunofluorescence tissue staining or electron microscopy in five patients who were studied. Human papillomavirus was not detected by immunocytochemistry or electron microscopy from tissue specimens of six patients. After therapy, biopsy specimens from two patients with complete responses revealed a normalization of histologic abnormalities and an inability to detect EBV in previously involved mucosa by immunofluorescence or in situ DNA hybridization assays. It was concluded that EBV replication within the epithelial cells of the tongue is necessary for the development of oral hairy leukoplakia.

Topics: Acyclovir; Administration, Oral; Adult; Candida albicans; Herpesvirus 4, Human; HIV Seropositivity; Humans; Leukoplakia, Oral; Male; Middle Aged; Remission Induction

Oral hairy leukoplakia was treated in six patients with (a) acyclovir (i.v. or p.o.), (b) 0.1% vitamin-A acid solution or (c) human beta-interferon-gel (10(5) I.E./g) in a total of 23 therapeutic courses. In 5/6 patients, acyclovir (7.5 mg/kg every 8 h i.v. or 5 x 400 mg p.o. over 5-10 days) led to partial (n = 1) or complete (n = 4) remission. After 1-6 months, however, the leukoplakia recurred in all cases. Vitamin-A acid solution (n = 3) led to remission in one and to improvement in the others. Human beta-interferon gel (n = 3) had no visible effect. The efficacy of acyclovir is further evidence of the concept that the Epstein-Barr virus is a major cause of oral hairy leukoplakia.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Administration, Oral; AIDS-Related Complex; Drug Therapy, Combination; Humans; Infusions, Intravenous; Interferon Type I; Leukoplakia, Oral; Mouth Mucosa; Neoplasm Staging; Tretinoin

Viral infections, predominantly those of the herpes virus family, account for up to 16% of all clinically significant infections in AIDS patients. Acyclovir has provided successful treatment in AIDS patients suffering from severe herpes simplex and herpes zoster virus infections. Preliminary results are presented on newly developed acyclovir analogues. Desciclovir, an oral prodrug of acyclovir which is metabolized to acyclovir in vivo, allows treatment of virus infections per os, where high serum levels are needed, e.g. in Epstein-Barr virus infections. BW B759U, another analogue of acyclovir, has been used for the treatment of life-threatening or sight-threatening cytomegalovirus infections in AIDS patients. More than 80% of the patients treated for retinitis experienced stabilization or clinical improvement. Antiviral efficacy was demonstrated in 73% of the patients. Azidothymidine, a nucleoside analogue of thymidine, has been developed specifically to treat the HIV infection. Its antiviral activity is based on inhibition of reverse transcriptase. Phase I studies have demonstrated that azidothymidine is well tolerated. Its ability to cross the blood brain barrier makes it an attractive candidate for treatment of HIV. Trials to determine efficacy are in progress.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Herpes Simplex; Herpes Zoster; Herpesvirus 4, Human; Humans; Leukoplakia, Oral; Opportunistic Infections; Thymidine; Tumor Virus Infections; Virus Diseases; Zidovudine

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Humans; Leukoplakia, Oral; Male; Middle Aged; Retinitis; Tongue Neoplasms

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Diterpenes; Humans; Leukoplakia, Oral; Retinyl Esters; Vitamin A

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Herpes Zoster; Herpesvirus 4, Human; Humans; Leukoplakia, Oral; Male; Tumor Virus Infections