acyclovir and Lymphoma--AIDS-Related

Herpes viruses are characterized by their ability to establish and maintain latent infections that can be reactivated. Several stimuli can trigger the reactivation of herpes viruses, which are perhaps best recognized in the recurrent blisters and ulcers associated with herpes simplex virus. We present two clinical cases of reactivation of herpes simplex virus during radiation therapy for management of cancers of the head and neck. Although the role of ionizing radiation in the reactivation of herpes simplex virus has not been established, we review the viral and host events associated with the establishment of orofacial herpes simplex virus infection, latency, and reactivation of the virus. We discuss current models of viral reactivation and suggest directions for further clinical research into the reactivation of orolabial herpes simplex virus during radiotherapy.

Topics: Acyclovir; Adult; Antiviral Agents; Carcinoma, Squamous Cell; Cerebellar Neoplasms; Head and Neck Neoplasms; Humans; Immunocompromised Host; Lymphoma, AIDS-Related; Lymphoma, B-Cell; Lymphoma, Large-Cell, Immunoblastic; Male; Middle Aged; Nasopharyngeal Neoplasms; Radiotherapy; Recurrence; Simplexvirus; Stomatitis, Herpetic; Virus Activation; Virus Latency

Detection of Epstein-Barr virus (EBV) DNA in the cerebrospinal fluid (CSF) is associated with acquired immunodeficiency syndrome (AIDS)-related brain lymphoma. Real-time polymerase chain reaction (PCR) was performed to quantify EBV DNA in CSF and plasma from 42 patients with AIDS-related non-Hodgkin's lymphoma (NHL). Twenty patients had primary central nervous system lymphoma (PCNSL) and 22 systemic NHL, including 12 with central nervous system involvement (CNS-NHL). As controls, 16 HIV-infected patients with other CNS disorders were examined. EBV DNA was detected in the CSF from 16/20 (80%) patients with PCNSL, 7/22 (32%) with systemic NHL, 8/12 (67%) with CNS-NHL, and 2/16 (13%) of the controls. The viral EBV DNA levels were significantly higher in the CSF from patients with PCNSL or CNS-NHL compared to patients with systemic NHL or controls. EBV DNA was detected in plasma from 5/16 (31%) patients with PCNSL, 9/16 (56%) with systemic NHL, 4/9 (44%) with CNS-NHL, and 4/15 (27%) controls. No difference in plasma viral load was found between patient groups. From the patients with CNS-NHL, plasma samples drawn prior to CNS involvement contained significantly higher EBV DNA levels than those from systemic NHL patients without subsequent CNS involvement. EBV DNA levels in the CSF, but not in plasma, from patients treated with antiherpes drugs were significantly lower than in untreated patients. High CSF EBV DNA levels were found in HIV-associated brain lymphomas and the viral load can be clinically useful. High plasma EBV DNA levels might predict CNS involvement in systemic NHL.

Topics: Acyclovir; Antiviral Agents; Biomarkers, Tumor; Burkitt Lymphoma; Central Nervous System Neoplasms; DNA, Viral; Epstein-Barr Virus Infections; Ganciclovir; Herpesvirus 4, Human; Humans; Lymphoma, AIDS-Related; Lymphoma, Large B-Cell, Diffuse; Polymerase Chain Reaction; Retrospective Studies; Viral Load

Topics: Acyclovir; Antiviral Agents; Humans; Lymphoma, AIDS-Related; Lymphoma, Non-Hodgkin; Risk

Acyclovir or similar agents with activity against Epstein-Barr virus (EBV) theoretically may prevent non-Hodgkin's lymphoma (NHL) in AIDS. A case-control study of 29 patients with AIDS-related NHL and 58 matched control subjects assessed the frequency with which daily acyclovir (>/=800 mg/d) or similar agents were used for > or =1 year. In a historical cohort of 304 patients with AIDS for > or =2 years, the prevalence of NHL was assessed among 3 groups of patients: those who received long-term treatment with high-dose acyclovir (or similar agents) or low-dose or intermittent acyclovir; those treated with ganciclovir/foscarnet for <1 year; and those who had not previously been treated with acyclovir, ganciclovir, or foscarnet. In the case-control study, 22 patients (72.4%) with NHL never received acyclovir or similar drugs versus 19 control subjects (32.8%; P=. 002); 2 patients (6.9%) with NHL received acyclovir (> or =800 mg/d) for > or =1 year versus 27 (46.6%) of control subjects (P=.0001). In the cohort study, 6 (6.8%) of 88 patients who received acyclovir (> or =800 mg/d) for > or =1 year developed NHL versus 15 (15.5%) of 97 patients who received intermittent or lower-dose acyclovir and 30 (25.2%) of 119 patients who never received these agents (P=.002). Long-term administration (>1 year) of high-dose acyclovir or similar agents with anti-EBV activity may prevent NHL in patients with AIDS. A prospective, randomized study is warranted to confirm these results.

Topics: Acyclovir; Adult; Antiviral Agents; Case-Control Studies; Cohort Studies; Drug Therapy, Combination; Epstein-Barr Virus Infections; Female; Foscarnet; Ganciclovir; Humans; Lymphoma, AIDS-Related; Male; Middle Aged; Time Factors

Two HIV patients with Epstein-Barr virus (EBV)-associated B cell lymphoma of high grade malignancy enjoyed prolonged remission after therapy with COPBLAM and the antiviral agent Acyclovir. After 3, respectively 5 cycles of treatment, the patients (stage C3 according to CDC) responded to the administered drugs by achieving complete remission. Under maintenance therapy with Acyclovir for 32, respectively 31 months, both patients still remain free of lymphoma as of today.

Topics: Acyclovir; Adult; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Bleomycin; Burkitt Lymphoma; Cyclophosphamide; Doxorubicin; Humans; Lymphoma, AIDS-Related; Lymphoma, Non-Hodgkin; Male; Middle Aged; Prednisone; Procarbazine; Remission Induction; Vincristine