acyclovir and Neuralgia--Postherpetic

The most refractory symptom of herpes zoster (HZ) is pain. Approximately 90% of people who have HZ suffer from pain. Early use of antiviral medications has been found to reduce pain across all stages of the disease. Although many antiviral agents via oral or intravenous administration were recommended by clinical practice, the best approach to prevent HZ-associated pain remains uncertain.. The purpose of this study was to compare the efficacy and adverse events of various antiviral agents used for the treatment of HZ-associated pain through a network meta-analysis.. A systematic review and meta-analysis.. The Cochrane Register of Controlled Trials, Embase, and PubMed were searched from inception to Feb 2020.. Randomized clinical trials evaluating antiviral agents currently available for treating HZ-associated pain were included. We extracted data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and conducted network meta-analyses with random-effects models. The primary outcome was the presence of acute pain at the end of anti-virus treatment, and the secondary outcomes included the presence of pain at 28-30 days after the onset of the acute herpetic rash, the presence of postherpetic neuralgia (PHN), and any other adverse events.. A total of 17 randomized control trials with 5,579 participants were included in this study. According to the results of the network meta-analysis, for the treatment of acute pain, there was no significant difference between oral acyclovir and intravenous acyclovir. Furthermore, oral famciclovir was the most effective treatment concerning both the odds ratio (OR) (superior to placebo OR = 0.25; 95% CI: 0.13~0.48) and the surface under the cumulative ranking curve (SUCRA) values of 0.84 for the treatment of acute pain among all the oral antiviral agents. For the presence of pain at 28-30 days, no significant difference was observed in efficacy between all antiviral treatments and placebo concerning the OR; however, oral valaciclovir ranked first (SUCRA values of 0.96). For the presence of NPH, oral famciclovir was determined to be the most effective (SUCRA values of 0.77) treatment with an efficacy of 0.42 (95% CI: 0.18~0.99) versus placebo. For adverse events, there was no significant difference between oral antivirals and placebo; however, intravenous acyclovir ranked last with a score of OR 4.31 (95% CI: 1.26~14.75) versus placebo.. The distribution of severity of pain was different in various studies; then, the lack of availability of individual data prevented us from analyzing the effects of the risk factors.. For the treatment of acute pain and PHN, oral famciclovir was the most effective treatment among all the oral antiviral agents. For alleviating pain after 28-30 days, oral valaciclovir appeared to be the most effective among all antiviral agents. Additionally, all oral antiviral agents were well tolerated.. PROSPERO under the identification CRD42020212834.

Topics: Acute Pain; Acyclovir; Antiviral Agents; Famciclovir; Herpes Zoster; Humans; Network Meta-Analysis; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic; Valacyclovir

Topics: Acyclovir; Antiviral Agents; Blister; Famciclovir; Herpes Zoster; Humans; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic; Valacyclovir

Postherpetic neuralgia (PHN) is a painful and refractory complication of herpes zoster. Treatments are either partially or totally ineffective for many people with PHN. Antiviral agents, used at the time of the rash, have been proposed as an intervention to prevent the development of PHN. This is the first update since the first publication of the review in 2009.. To assess the effectiveness of antiviral agents in preventing PHN.. On 26 April 2013, we updated the searches in the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, and the Chinese Biomedical Retrieval System. We checked the references of published studies to identify additional trials, and contacted authors to obtain additional data. We searched other databases in The Cochrane Library for information for the Discussion and two clinical trials registries for ongoing trials.. We considered all randomised controlled trials (RCTs) of antiviral treatment given within 72 hours after the onset of herpes zoster for preventing PHN. There were no language restrictions.. Two authors independently selected trials, evaluated the risk of bias in included trials, and extracted and analysed data.. Six RCTs with a total of 1211 participants were eligible; five trials evaluated oral aciclovir, and one, with 419 participants, evaluated oral famciclovir. We were able to conduct meta-analyses as there were sufficient similarities in the included studies, such as the reporting of the presence of PHN, duration of rash before treatment initiation and treatment regimen. For our primary outcome, based on three trials (609 participants) we found no significant difference between the aciclovir and control groups in the incidence of PHN four months after the onset of the acute herpetic rash (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.51 to 1.11), nor was there a significant difference at six months (RR 1.05, 95% CI 0.87 to 1.27, two trials, 476 participants). In four of the trials (692 participants), there was some evidence for a reduction in the incidence of pain four weeks after the onset of rash. In the trial of famciclovir versus placebo, neither 500 mg nor 750 mg doses of famciclovir reduced the incidence of herpetic neuralgia significantly. The most commonly reported adverse events were nausea, vomiting, diarrhoea and headache for aciclovir, and headache and nausea for famciclovir. For neither treatment was the incidence of adverse events significantly different from placebo. None of the studies were at high risk of bias, although the risk of bias was unclear in at least one domain for all but one study. We found no new RCTs when we updated the searches in April 2013.. There is high quality evidence that oral aciclovir does not reduce the incidence of PHN significantly. In addition, there is insufficient evidence to determine the effect of other antiviral treatments; therefore, further well-designed RCTs are needed to investigate famciclovir or other new antiviral agents in preventing PHN. Future trials should pay more attention to the severity of pain and quality of life of participants, and should be conducted among different subgroups of people, such as people who are immunocompromised.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Humans; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic

Varicella zoster virus (VZV) reactivation results in zoster, which may be complicated by postherpetic neuralgia, myelitis, meningoencephalitis, and VZV vasculopathy. This review highlights the clinical features, laboratory abnormalities, imaging changes, and optimal treatment of each of those conditions. Because all of these neurological disorders produced by VZV reactivation can occur in the absence of rash, the virological tests proving that VZV caused disease are discussed.. After primary infection, VZV becomes latent in ganglionic neurons along the entire neuraxis. With a decline in VZV-specific cell-mediated immunity, VZV reactivates from ganglia and travels anterograde to the skin to cause zoster, which is often complicated by postherpetic neuralgia. VZV can also travel retrograde to produce meningoencephalitis, myelitis, and stroke. When these complications occur without rash, VZV-induced disease can be diagnosed by detection of VZV DNA or anti-VZV antibody in cerebrospinal fluid and treated with intravenous acyclovir.. Awareness of the expanding spectrum of neurological complications caused by VZV reactivation with and without rash will improve diagnosis and treatment.

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; DNA, Viral; Encephalitis, Varicella Zoster; Herpes Zoster; Herpesvirus 3, Human; Humans; Myelitis; Neuralgia, Postherpetic; Vascular Diseases; Virus Latency

Herpes zoster (Hz), which generally presents as a localized, painful cutaneous eruption, is a common clinical problem, particularly among adults ≥ 50 years of age and immunocompromised patients. The diagnosis of Hz is mainly made clinically, except in patients with atypical manifestations or certain complications, such as central nervous system involvement, in which laboratory virologic testing is required. In addition to having a higher mortality rate, immunocompromised individuals have atypical and severe clinical findings and are at greater risk for complications and recurrence of Hz. Treatment of Hz includes the use of antiviral agents, analgesics for control of acute zoster pain, good skin care for healing, and prevention of secondary bacterial infection. Antiviral agents, preferably valacyclovir or famciclovir, should be started within 72 hours of onset to reduce the severity of the infection, the duration of the eruptive phase, and the intensity of acute pain. Herpes zoster has been associated with several complications, of which post-herpetic neuralgia (PHN) is the most common and debilitating. Varicella-zoster virus vaccine and early treatment with either famciclovir or valacyclovir are the only measures proven to prevent PHN. The options for treating PHN include topical agents, such as lidocaine patches, and systemic agents, such as the anticonvulsants gabapentin and pregabalin. Measures for preventing Hz include infection control through routine hand hygiene and appropriate use of isolation precautions and personal protective equipment; immunoglobulins, such as the varicella-zoster virus immunoglobulin and vaccine; and antiviral agents. The zoster vaccine has been shown to be effective in reducing the incidence of Hz and PHN. The vaccine is recommended for all individuals aged ≥ 60 years who have no contraindications, including individuals who report a previous episode of Hz.

Topics: 2-Aminopurine; Acyclovir; Adult; Aged; Aged, 80 and over; Analgesics; Antiviral Agents; Cohort Studies; Famciclovir; Female; Herpes Zoster; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Incidence; Lidocaine; Male; Middle Aged; Neuralgia, Postherpetic; Practice Guidelines as Topic; Retrospective Studies; Risk Factors; United States; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antiviral Agents; Cross-Sectional Studies; Diagnosis, Differential; DNA, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Neurologic Examination; Opportunistic Infections; Pain Measurement; Polymerase Chain Reaction; Prognosis; Quality of Life; Risk Factors

Herpes zoster is due to the reactivation of the virus causing varicella, called varicella-zoster virus. It affects peripheral nerves and causes painful skin and nerve lesions. This pain may last for months, or years after the initial lesions have resolved: post-herpetic neuralgia is the most frequent complication. Antiviral drugs, acting directly on the infectious agent are prescribed to reduce or block viral replication, relieve pain, and shorten symptom duration, especially for people of 50 years of age or more. However, there is currently no systematic collection of data concerning the effectiveness of antiviral drugs administered outside of clinical trials. This review evaluates the effectiveness of antiviral drugs on: (a) the intensity of pain and progression of the rash during the acute phase of herpes zoster, and (b) the frequency, intensity, and duration of post-herpetic neuralgia. During the acute phase, antiviral drugs (acyclovir, valacyclovir and famcyclovir) significantly reduce the intensity of acute pain, accelerate the healing of the vesicular rash, and reduce the duration of viral excretion. According to some authors, these drugs taken at an early stage of the disease would help to prevent the development of post herpetic neuralgia. But for others, there is no convincing evidence that antiviral drugs reduce the risk of painful complications.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Age Factors; Aged; Antiviral Agents; Drug Administration Schedule; Drug Evaluation; Early Diagnosis; Famciclovir; Global Health; Herpes Zoster; Humans; Meta-Analysis as Topic; Middle Aged; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Postherpetic neuralgia is a common serious complication of herpes zoster. Corticosteroids are anti-inflammatory and might be beneficial.. To examine the efficacy of corticosteroids in preventing postherpetic neuralgia.. We updated the searches for randomised controlled trials of corticosteroids for preventing postherpetic neuralgia in MEDLINE (January 1950 to February 2010), EMBASE (January 1980 to February 2010), LILACS (January 1982 to February 2010), the Chinese Biomedical Retrieval System (1978 to 2010 ) and the Cochrane Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2010). We also reviewed the bibliographies of identified trials, contacted authors and approached pharmaceutical companies to identify additional published or unpublished data.. We included all randomised controlled trials involving corticosteroids given by oral, intramuscular or intravenous routes for people of all ages with herpes zoster of all degrees of severity within seven days after onset, compared with no treatment or placebo, but not with other treatments.. Two authors identified potential articles, extracted data and assessed quality of each trial independently. Disagreement was resolved by discussion with other co-authors.. Five trials were included with 787 participants in total. All were randomised, double-blind, placebo-controlled parallel group studies. No new trials were identified in the 2010 update. In the updated version we conducted a meta-analysis of two trials, and the results showed that oral corticosteroids did not prevent postherpetic neuralgia six months after the herpes onset (RR, 0.95; 95% CI 0.45 to 1.99). The three other included trials also had similar results although their data could not be included in the meta-analysis. Adverse events during or within two weeks after stopping treatment were reported in all five included trials. There were no significant differences in serious or non-serious adverse events between the corticosteroids and placebo groups.. Corticosteroids given acutely during zoster infection are ineffective in preventing postherpetic neuralgia. In people with acute herpes zoster the risks of administration do not appear to be great. Corticosteroids have been recommended to relieve the zoster-associated pain in the acute phase of disease; if further research is designed to evaluate the efficacy of corticosteroids for herpes zoster, long-term follow-up should be included to observe their effect on the transition from acute pain to postherpetic neuralgia. Future trials should include measurements of function and quality of life.

Topics: Acyclovir; Adrenocorticotropic Hormone; Antiviral Agents; Glucocorticoids; Humans; Neuralgia, Postherpetic; Prednisolone; Prednisone; Randomized Controlled Trials as Topic; Triamcinolone

Postherpetic neuralgia (PHN) is a painful and refractory complication of herpes zoster. Treatments are either partially or totally ineffective for many people with PHN. Antiviral agents, used at the time of the rash, are one of the best-established approaches that may prevent the development of PHN.. To investigate the effectiveness of antiviral agents in preventing PHN.. We searched the Cochrane Neuromuscular Disease Group Trials Register (January 13 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 4), MEDLINE (January 1966 to November Week 3 2008), EMBASE (January 1980 to Week 02 2009), LILACS (January 1982 to 13 January 2009), and the Chinese Biomedical Retrieval System (January 1978 to 13 January 2009). We checked the references of published studies to identify additional trials.. All randomised and quasi-randomised controlled trials for antiviral treatment given within 72 hours after the onset of herpes zoster for preventing PHN irrespective of any language restrictions.. Two authors independently selected trials and evaluated the methodological quality, then extracted and analysed data from the included trials.. Twenty trials were identified. Twelve trials were excluded and two trials are awaiting classification. Six randomised controlled trials, with a total of 1211 participants were eligible; five trials evaluated oral acyclovir, and one trial with 419 participants evaluated oral famciclovir. There was no significant difference between the oral acyclovir and control groups on the incidence of PHN four months (risk ratio (RR), 0.75; 95% CI 0.51 to 1.11; P = 0.15) or six months (RR 1.05, 95% CI 0.87 to 1.27; P = 0.62) after the onset of the acute herpetic rash. There was some evidence for a reduction in the incidence of pain four weeks after the onset of rash. In the trial of famciclovir versus placebo, neither 500 mg and 750 mg doses of famciclovir reduced the incidence of herpetic neuralgia significantly.. Oral acyclovir did not reduce the incidence of PHN significantly. There is insufficient evidence from randomised controlled trials to determine whether other antiviral treatments prevent PHN. Additional well-designed, randomised controlled trials of famciclovir or other new antiviral agents, with a greater number of participants are needed. Future trials should pay more attention to the severity of pain and quality of life of participants, and should be conducted among different subgroups of people, such as people who are immunocompromised.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Humans; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic

Evaluation of evidence-based strategies for managing herpes zoster (HZ) and the pain of postherpetic neuralgia (PHN).. Approximately 20% of the world's population suffers from herpes zoster at least once in a lifetime, with 10% to 20% having ophthalmic involvement. Treatment of the acute disease with oral antivirals may reduce the incidence and severity of complications but does not reliably prevent PHN or postherpetic itch (PHI). The acute pain abates as the acute phase resolves; the long-term pain of PHN or PHI may be severe and difficult to manage. Although many therapeutic agents have efficacy in the management of these complications, relief is frequently partial for months to the remainder of the lifetime.. Literature review was performed using the resources of the Harvard Medical School/Massachusetts Eye and Ear Infirmary Ophthalmic library as well as the National Library of Medicine and the National Institutes of Health PubMed service searching by pertinent topics, authors, and journals.. If started within 72 hours of the onset of the acute HZ rash, the oral antiviral agents acyclovir, valacyclovir, and famciclovir significantly shorten the periods of acute pain, virus shedding, rash, acute and late-onset anterior segment complications, and, in the case of valacyclovir and famciclovir, the incidence and severity of PHN. However, these medications do not prevent PHN, which remains a common and debilitating complication of HZ in older patients, requiring assiduous pain management. Tricyclic antidepressants, antiseizure drugs, opioids, and topical analgesics all offer some pain relief, and may be combined.. Options are available to manage HZ and reduce the pain of PHN. However, prevention, now possible with the HZ vaccine, is preferable to treatment.

Topics: 2-Aminopurine; Acyclovir; Analgesics; Analgesics, Opioid; Anticonvulsants; Antidepressive Agents, Tricyclic; Antiviral Agents; Drug Therapy, Combination; Famciclovir; Glucocorticoids; Herpes Zoster Ophthalmicus; Humans; Neuralgia, Postherpetic; Valacyclovir; Valine

To review the evidence regarding treatment of herpes zoster (HZ) in the short-term, focusing on the prevention of postherpetic neuralgia (PHN).. The evidence relating to treatment of HZ is derived mainly from randomized controlled trials (level I evidence).. Antiviral drugs might have some effect on the severity of acute pain and on the duration of skin lesions. Corticosteroids also alleviate acute pain. Oral antiviral medication reduces the risk of eye complications in patients with ophthalmic HZ. There is no convincing evidence that antiviral medication reduces the risk of PHN. Some studies, however, have shown that famciclovir and valacyclovir shorten the duration of PHN. The effectiveness of amitriptyline or cutaneous and percutaneous interventions in preventing PHN has not been proven.. Oral antiviral drugs should be prescribed to elderly HZ patients with high risk of PHN. Moreover, these drugs should be prescribed to all patients at the first signs of ophthalmic HZ, irrespective of age or severity of symptoms.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Glucocorticoids; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Neuralgia, Postherpetic; Prednisolone; Time Factors; Valacyclovir; Valine

We have analysed zoster-associated pain treated with valaciclovir (VCV) in immunocompetent patients with acute herpes zoster over 6 months, and evaluated the safety of VCV. We know of no reports that evaluate postherpetic neuralgia (PHN) treated with VCV for 6 months. Predisposing factors that influence PHN were age (over 60 years), clustered vesicles, severity of eruption, sleep disturbance, and hypesthesia. Timing of the administration of VCV before or after the onset of rash did not influence the incidence of PHN. No serious adverse reactions were observed during the administration of VCV.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Female; Follow-Up Studies; Herpes Zoster; Humans; Immunocompetence; Kaplan-Meier Estimate; Male; Middle Aged; Neuralgia, Postherpetic; Pain Measurement; Surveys and Questionnaires; Treatment Outcome; Valacyclovir; Valine

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Administration, Oral; Adult; Age Factors; Analgesics, Non-Narcotic; Analgesics, Opioid; Anticonvulsants; Antidepressive Agents, Tricyclic; Antiviral Agents; Bromodeoxyuridine; Child; Drug Therapy, Combination; Famciclovir; Female; Herpes Zoster; Herpesvirus 3, Human; Herpesvirus Vaccines; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain; Prodrugs; Risk Factors; Sex Factors; Time Factors; Vaccination; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Amines; Antidepressive Agents, Tricyclic; Antiviral Agents; Arabinofuranosyluracil; Cyclohexanecarboxylic Acids; Famciclovir; Gabapentin; gamma-Aminobutyric Acid; Humans; Neuralgia, Postherpetic; Valacyclovir; Valine

Treatment of established postherpetic neuralgia (PHN) is difficult and often disappointing. In this study, we assessed the efficacy of repetitive intracutaneous injections with local anesthetics and steroids in acute thoracic herpes zoster (HZ) pain, herpetic eruption, and incidence of PHN.. Ninety-three patients with acute thoracic HZ were randomly assigned to receive a standard treatment of antiviral medication with p.o. analgesics or the standard treatment with the addition of repetitive intracutaneous injections of a local anesthetic and steroid mixture. Patients were permitted to take tramadol when the visual analog scale (VAS) ≥ 4. Pain assessment using VAS was conducted at the initial visit, as well as 1, 2, 4, 12, and 24 weeks after the end of the treatments.. In comparison with the standard treatment group, the VAS scores of the intracutaneous injection group were significantly lower during the study. The intracutaneous injection group also reported shorter duration of pain and skin eruption than the control group ( P  = 0.005 vs P  < 0.001, respectively). At 1 month post-therapy, 12.8% patients in the intracutaneous injection group reported zoster-associated pain, compared with 47.8% in the standard treatment group ( P  < 0.001). At 3 and 6 months post-therapy, the incidence of PHN was still significantly lower in the intracutaneous injection group than the standard treatment group. EuroQol VAS scores were significantly higher in the intracutaneous injection group vs standard treatment group (P < 0.001).. Repetitive intracutaneous injections with local anesthetics and steroids along with standard treatment significantly reduce the duration of pain and herpetic eruption and incidence of PHN.

Topics: Acyclovir; Aged; Aged, 80 and over; Amides; Analgesics, Opioid; Anesthetics, Local; Antiviral Agents; Female; Herpes Zoster; Humans; Incidence; Injections, Intradermal; Male; Methylprednisolone; Middle Aged; Neuralgia, Postherpetic; Neuroprotective Agents; Pain Measurement; Ropivacaine; Tramadol

This prospective, parallel-group, randomized, double-blind, multicenter study compared the efficacy and safety of FV-100 with valacyclovir for reducing pain associated with acute herpes zoster (HZ). Patients, ≥50 years of age, diagnosed with HZ within 72 h of lesion appearance who had HZ-associated pain, were randomized 1:1:1 to a 7-day course of either FV-100 200 mg QD (n = 117), FV-100 400 mg QD (n = 116), or valacyclovir 1000 mg TID (n =117). Efficacy was evaluated on the basis of the burden of illness (BOI; Zoster Brief Pain Inventory scores); incidence and duration of clinically significant pain (CSP); pain scores; incidence and severity of post-herpetic neuralgia (PHN); and times to full lesion crusting and to lesion healing. Safety was evaluated on the basis of adverse event (AE)/SAE profiles, changes in laboratory and vital signs values, and results of electrocardiograms. The burden of illness scores for pain through 30 days were 114.5, 110.3, and 118.0 for FV-100 200 mg, FV-100 400 mg, and valacyclovir 3000 mg, respectively. The incidences of PHN at 90 days for FV-100 200 mg, FV-100 400 mg, and valacyclovir 3000 mg were 17.8%, 12.4%, and 20.2%, respectively. Adverse event and SAE profiles of the two FV-100 and the valacyclovir groups were similar and no untoward signals or trends were evident. These results demonstrate a potential for FV-100 as an antiviral for the treatment of shingles that could both reduce the pain burden of the acute episode and reduce the incidence of PHN compared with available treatments.

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Cost of Illness; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain; Pain Management; Prospective Studies; Pyrimidine Nucleosides; Valacyclovir; Valine

Postherpetic neuralgia (PHN) is a chronic neuropathic pain that results from alterations of the peripheral nervous system in areas affected by the herpes zoster virus. The symptoms include pain, paresthesia, dysesthesia, hyperalgesia, and allodynia. Despite the availability of pharmacological treatments to control these symptoms, no treatments are available to control the underlying pathophysiology responsible for this disabling condition.. Patients with herpes zoster who are at least 50 years old and have a pain score of 4 or higher on a visual analogue scale (VAS) will be recruited. The aim is to recruit 134 patients from the practices of general physicians. Participants will be randomized to receive gabapentin to a maximum of 1800 mg/day for 5 weeks or placebo. Both arms will receive 1000-mg caplets of valacyclovir three times daily for 7 days (initiated within 72 h of the onset of symptoms) and analgesics as needed. The primary outcome measure is the percentage of patients with a VAS pain score of 0 at 12 weeks from rash onset. The secondary outcomes measures are changes in quality of life (measured by the SF-12 questionnaire), sleep disturbance (measured by the Medical Outcomes Study Sleep Scale), and percentage of patients with neuropathic pain (measured by the Douleur Neuropathique in 4 Questions).. Gabapentin is an anticonvulsant type of analgesic that could prevent the onset of PHN by its antihypersensitivity action in dorsal horn neurons.. ISRCTN Registry identifier: ISRCTN79871784 . Registered on 2 May 2013.

Topics: Acyclovir; Amines; Analgesics; Antiviral Agents; Clinical Protocols; Cyclohexanecarboxylic Acids; Double-Blind Method; Female; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain Measurement; Quality of Life; Research Design; Sleep; Spain; Surveys and Questionnaires; Time Factors; Treatment Outcome; Valacyclovir; Valine

Postherpetic neuralgia (PHN) is a sequela of herpes zoster that adversely affects quality of life seriously. The risk factors for PHN are well known but the effective interventions that reduce the incidence of PHN are less studied. The objective of this study is to evaluate the efficacy of treatment with gabapentin in patients with acute herpes zoster for preventing PHN. We performed a prospective randomized controlled study of 120 participants diagnosed with acute herpes zoster, aged 50 and over and complaining moderate to severe pain. All patients were treated with valacyclovir and acetaminophen. Half of the participants were assigned to the gabapentin group and received gabapentin 300 mg three times a day additionally. The intensity of pain at every visit and the incidence of PHN in both groups were measured. Total 52 and 49 patients in the gabapentin group and the control group, respectively, had completed 12 weeks of follow-up period. Although the incidence of PHN was higher in the control group, the difference was not statistically significant (6.1% vs. 3.8%, p = 0.67). Our results indicate that the use of low-dose gabapentin in acute herpes zoster seems not effective in the prevention of PHN.

Topics: Acetaminophen; Acyclovir; Aged; Aged, 80 and over; Amines; Analgesics; Analgesics, Non-Narcotic; Antiviral Agents; Cyclohexanecarboxylic Acids; Drug Therapy, Combination; Female; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain Measurement; Prospective Studies; Quality of Life; Republic of Korea; Time Factors; Treatment Outcome; Valacyclovir; Valine

To evaluate the clinical efficacy of intradermal injection of methylene blue for treatment of moderate to severe acute thoracic herpes zoster and prevention of postherpetica neuralgia in elderly patients.. Sixty-four elderly patients with herpes zoster were randomized to receive a 10-day course of intradermal injection of methylene blue and lidocaine plus oral valaciclovir (group A, 32 cases) and intradermal injection of lidocaine plus oral valaciclovir (group B).Herpes evaluation index, pain rating index, incidence of postherpetic neuralgia, and comprehensive therapeutic effect were compared between the two groups at 11, 30 and 60 days after the treatment.. The baseline characteristics were comparable between the two groups (all P>0.05). Compared with that in group B, the time for no new blister formation, blister incrustation and decrustation, and pain relief was significantly shortened in group A (P<0.05) with also obviously lower pain intensity after the treatment. The incidence of postherpetic neuralgia was significantly lower in group A than in group B at 30 days (P<0.05), but not at 60 and 90 days after the treatment. The total clinical response rate was 93.8% in group A, much higher than that in group B (62.5%, P<0.05).. Intradermal injection of methylene blue can effectively shorten the disease course, reduce the pain intensity and prevent the development of postherpetic neuralgia in elderly patients with herpes zoster.

Topics: Acyclovir; Aged; Herpes Zoster; Humans; Incidence; Injections, Intradermal; Lidocaine; Methylene Blue; Neuralgia, Postherpetic; Pain Measurement; Valacyclovir; Valine

Herpes zoster neural injury was assessed by determining cutaneous nerve density in skin biopsies from the affected dermatomes of 35 adult patients with herpes zoster in the acute phase and 3 months post-treatment, using protein gene product 9.5 immunohistochemistry. In contrast to the significant increase in subepidermal nerve fibre density (11.77 ± 4.88/mm vs. 13.29 ± 5.74/mm, p = 0.045) after 3 months, no differences were found in epidermal free nerve endings (2.43 ± 2.35/mm and 2.8 ± 2.86/mm, p = 0.168). Patients with post-herpetic neuralgia had significantly lower subepidermal nerve fibre densities (9.7 ± 2.05/mm vs. 14.72 ± 6.13/mm, p = 0.011) compared with non-post-herpetic neuralgia patients. No differences in cutaneous nerve density were found in relation to antiviral therapy. In conclusion, 3 months after acute infection, no sign of epidermal innervation recovery is observed, while the increased subepidermal nerve fibre density in the affected dermatomes probably reflects nerve regeneration that is not affected by antiviral agent type. Subepidermal nerve fibre density is decreased in patients with post-herpetic neuralgia 3-months post-acute herpes zoster infection.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Biomarkers; Biopsy; Bromodeoxyuridine; Famciclovir; Female; Herpes Zoster; Humans; Immunohistochemistry; Male; Middle Aged; Nerve Fibers; Neuralgia, Postherpetic; Skin; Ubiquitin Thiolesterase; Valacyclovir; Valine

Various treatments have been used to manage post-herpetic neuralgia (PHN). Safe and effective therapies to prevent PHN are needed.. A clinical trial involving 152 patients diagnosed with acute herpes Zoster (HZ) was conducted to determine whether short-course acyclovir therapy (800 mg five times a day for four days) can alleviate HZ-associated pain and prevent post-herpetic neuralgia (PHN).  The patients were divided into two groups: Group 1 had a rash with a duration of less than 72 hours and Group 2 had a rash with a duration of more than 72 hours. To assess PHN, the patients categorized and assessed the severity of their symptoms using a four-point verbal rating scale (VRS).. By the fourth week, 134 out of 152 patients (88.2%) had complete pain response (CPR). Of these, 68 patients (89.5%) were from Group 1 and 66 from Group 2 (86.8%). After four weeks, the mean VRS scores had changed significantly in both groups compared to the scores at the beginning of study (p = 0.001), but there was no difference between the two groups (0.88 ± 0.66 Vs. 0.94 ± 0.72; p = 0.66) After three months no differences were observed in the treatment results between the two groups (0.51 ± 0.13 Vs.0.54 ± 0.19; p = 0.77).. Short-course acyclovir therapy is an effective treatment for zoster and its efficacy in patients with a rash duration of more than 72 hours is similar to that in patients with rash duration of less than 72 hours.

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Drug Administration Schedule; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain; Time Factors; Treatment Outcome

The treatment of postherpetic neuralgia (PHN) continues to be a challenge in clinical pain management. In this randomized, controlled study, we assessed the effectiveness of repetitive paravertebral injections with local anesthetics and steroids for the prevention of PHN in patients with acute herpes zoster.. One hundred thirty-two patients with acute herpes zoster diagnosed 1-7 days after the onset of the rash were randomly assigned to receive either standard therapy (oral antivirals and analgesics) or standard therapy with additional repetitive paravertebral injections of a mixture of 10 mL 0.25% bupivacaine and 40 mg methylprednisolone acetate every 48 h for a week. Efficacy was evaluated at 1, 3, 6, and 12 mo after the end of the treatments. The primary end point was the proportion of patients with zoster-associated pain and/or allodynia 1 mo after inclusion. Statistical analysis was performed based on the intent-to-treat population.. One hundred thirteen patients completed the 1-yr follow-up. At 1 mo posttherapy, 13% of patients in the paravertebral group reported zoster-related pain, compared with 45% in the standard group (P < 0.001). At 3, 6, and 12 mo posttherapy, the incidence of PHN was still significantly lower in the paravertebral group than in the standard group. The quality of life improved in both groups at each follow-up time point with no significant difference between groups.. Repetitive paravertebral anesthetic block in combination with steroids plus standard treatment with acyclovir and analgesics significantly reduced the incidence of PHN than the standard treatment alone.

Topics: Acute Disease; Acyclovir; Administration, Oral; Aged; Analgesics; Anesthetics, Local; Antiviral Agents; Bupivacaine; Drug Administration Schedule; Drug Combinations; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Injections; Male; Methylprednisolone; Methylprednisolone Acetate; Middle Aged; Nerve Block; Neuralgia, Postherpetic; Pain Measurement; Prospective Studies; Quality of Life; Steroids; Time Factors; Treatment Outcome

Postherpetic neuralgia (PHN) is a complication of shingles (herpes zoster), a painful rash due to varicella-zoster virus reactivation. Studies of patients with PHN and zoster sine herpete (radicular pain without rash) support the notion that low-grade viral ganglionitis contributes to pain. If chronic pain reflects active infection, then antiviral therapy may help patients with PHN.. To determine whether antiviral treatment helps reduce PHN-associated pain.. Prospective, open-label phase I/II clinical trial.. Tertiary care university hospital.. Fifteen patients with moderate to severe PHN.. Intravenous acyclovir at a dosage of 10 mg/kg every 8 hours for 14 days followed by oral valacyclovir at a dosage of 1000 mg 3 times per day for 1 month.. Numeric Rating Scale for Pain score.. As defined by a decrease of 2 or more points on the Numeric Rating Scale for Pain, 8 (53%) of 15 patients reported improvement.. Clinical improvement reported by most of our patients warrants further investigation in a larger, randomized, double-blind, placebo-controlled trial.

Topics: Acyclovir; Administration, Oral; Aged; Aged, 80 and over; Antiviral Agents; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Male; Middle Aged; Neuralgia, Postherpetic; Prospective Studies; Treatment Outcome; Valacyclovir; Valine

Postherpetic neuralgia (PHN) is one of the common complications of herpes zoster infection, particularly in the elderly. Current therapeutic measures are only partially effective in the affected patients. As inflammatory mediators released by different cells play an important role in the pathogenesis of this neuropathic pain and with regard to the immunomodulatory effects of ultraviolet B (UVB) spectrum, we presumed that UVB phototherapy might be effective in the prevention of PHN.. This study was performed in two phases. Phase I was a prospective open controlled trial. Twenty-five patients with severe pain in the first 7 days of zoster rash were divided into two groups: the prevention group (n=12) received oral acyclovir (800 mg five times a day for 10 days) plus broad-band UVB to the affected dermatomes, starting with 20 mJ/cm(2) and gradually increasing the dose by 10 mJ/cm(2) each session to a maximum dose of 100 mJ/cm(2). Treatment sessions were repeated three times a week until pain relief or to a maximum of 15 sessions. The control group (n=13), who had disease characteristics similar to the prevention group, received only oral acyclovir with the same dose. All patients reported their severity of pain on a verbal rating scale (VRS, score 0-4) before treatment and at 1 and 3 months' follow-up. In phase II of the study, five patients with established PHN (more than 3 months after rash onset) received UVB with the above-mentioned protocol.. A total of 17 patients older than 40 (10 females, seven males; mean age, 65.5 years; range: 47-82 years) who had intractable pain due to zoster infection received UVB in two phases of the study. In patients who received phototherapy in the first 7 days of rash, 58.33% and 83.33% were completely pain free at 1-and 3-month follow-up, respectively. The corresponding figure in the control group was significantly lower (38.46% at 1 month and 53.85% at 3 months). The severity of pain was also lower in the phototherapy group than the control group (mean VRS 2.50 vs. 3.28 at 3 months). None of the patients who were treated more than 3 months after rash onset (established PHN) experienced significant (more than 50%) pain relief.. UVB phototherapy in the acute stage of zoster rash might reduce the incidence and severity of PHN. Treatment after 3 months does not seem to have a significant beneficial effect.

Topics: Acyclovir; Administration, Oral; Aged; Aged, 80 and over; Antiviral Agents; Combined Modality Therapy; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain Measurement; Prospective Studies; Severity of Illness Index; Treatment Outcome; Ultraviolet Therapy

This study aimed to explore the safety and clinical efficacy of light emitting diode (LED) golden light combined with acyclovir in treating herpes zoster (HZ). According to the random number table, 54 inpatients with HZ were divided into control group, golden-light group, and red-light group, with 18 cases in each group. The control group received acyclovir intravenous drip, while the patients in the red-light group received acyclovir intravenous drip and red-light LED phototherapy, and the golden-light group received acyclovir intravenous drip and golden-light LED phototherapy. Primary assessments included herpes stopping time, incrustation time, decrustation time, pain visual analog scale scores (VAS), and incidence of postherpetic neuralgia (PHN) on the 30th and 90th days. Golden-light group and red-light group showed a shorter herpes stopping time, incrustation time, and decrustation time (P < 0.05) compared to the control group (P < 0.05), while the golden-light group showed a shorter incrustation time and decrustation time than the red light group (all P < 0.05). After treatment VAS scores, the golden-light group showed a significant improvement compared to the control group. The golden-light group showed a better PHN incidence than the control group at 30 days follow-up. Compared with the comprehensive curative effect, the total effective rates of the golden-light group, red-light group, and control group were 88.89%, 77.78%, and 72.22%, respectively, and the efficacy of the golden-light group was better than that of the control group and red-light group. Golden light combined with acyclovir can shorten the course of HZ, relieve pain, and reduce the occurrence of PHN, and the effect is better than that of the red-light group and the control group.

Topics: Acyclovir; Herpes Zoster; Humans; Neuralgia, Postherpetic; Prospective Studies; Treatment Outcome

The molecular mechanisms of pain associated with alphaherpesvirus latency are not clear. We hypothesize that the voltage-gated sodium channels (VGSC) on the dorsal root ganglion (DRG) neurons controlling electrical impulses may have abnormal activity during latent viral infection and reactivation. We used herpes simplex virus 1 (HSV-1) to infect the human DRG-derived neuronal cell line HD10.6 in order to study the establishment and maintenance of viral latency, viral reactivation, and changes in the functional expression of VGSCs. Differentiated cells exhibited robust tetrodotoxin (TTX)-sensitive sodium currents, and acute infection significantly reduced the functional expression of VGSCs within 24 h and completely abolished VGSC activity within 3 days. A quiescent state of infection mimicking latency can be achieved in the presence of acyclovir (ACV) for 7 days followed by 5 days of ACV washout, and then the viruses can remain dormant for another 3 weeks. It was noted that during the establishment of HSV-1 latency, the loss of VGSC activity caused by HSV-1 infection could not be blocked by ACV treatment. However, neurons with continued ACV treatment for another 4 days showed a gradual recovery of VGSC functional expression. Furthermore, the latently infected neurons exhibited higher VGSC activity than controls. The overall regulation of VGSCs by HSV-1 during quiescent infection was proved by increased transcription and possible translation of Nav1.7. Together, these observations demonstrated a very complex pattern of electrophysiological changes during HSV infection of DRG neurons, which may have implications for understanding of the mechanisms of virus-mediated pain linked to latency and reactivation.

Topics: Acyclovir; Cell Line; Ganglia; Ganglia, Spinal; Gene Expression Regulation, Viral; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 1, Suid; Humans; Neuralgia, Postherpetic; Neurons; Transcriptome; Virus Activation; Virus Latency; Virus Replication

In 2016, the live attenuated zoster vaccine (Zostavax, Merck and Co, USA) was introduced into the Australian National Immunisation Program for people aged 70 years who are not significantly immunocompromised. We report the administration of Zostavax in an immunocompromised patient with chronic lymphocytic leukaemia and no evidence of primary varicella zoster virus (VZV) infection. The patient presented with a bilateral vesicular facial rash 22 days after receiving Zostavax and was initially managed as an outpatient with oral acyclovir. He re-presented three days later and was diagnosed with disseminated VZV infection complicated by meningoencephalitis. The patient died following cardiac arrest on day 10 of hospitalisation. This unfortunate case highlights the challenge of safely implementing a high titre live vaccine in a population where contraindications are prevalent. The non-live recombinant herpes zoster subunit vaccine (Shingrix, GSK) may provide a safe and effective option to protect immunocompromised patients from shingles and post-herpetic neuralgia.

Topics: Acyclovir; Aged; Antiviral Agents; Australia; Contraindications, Procedure; Exanthema; Fatal Outcome; Heart Arrest; Herpes Zoster; Herpes Zoster Vaccine; Hospitalization; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Meningoencephalitis; Neuralgia, Postherpetic; Vaccination; Vaccines, Attenuated; Varicella Zoster Virus Infection

Varicella Zoster Virus (VZV) is associated with many disorders of the central and peripheral nervous systems including neuralgia, meningitis, meningoencephalitis, cerebellitis, vasculopathy, myelopathy, Ramsay-Hunt syndrome, and polyneuritis cranialis. Cranial nerves V, VI, VII, VIII, IX, X, XI, and/or XII may be affected. The neurological disorders caused by VZV usually present with rash, but may rarely present without rash.. We herein present a case of polyneuritis cranialis without rash caused by VZV affecting cranial nerves VII, VIII, IX, and X. After excluding other causes of the condition, we diagnosed VZV infection based on VZV DNA in the CSF and an elevated anti-VZV IgG level in serum. The patient responded well to antiviral therapy.. VZV infection should be kept in mind during the differential diagnosis of polyneuritis cranialis; it is important to note that VZV re-activation may occur without rash.

Topics: Acyclovir; Antiviral Agents; Cranial Nerve Diseases; Facial Nerve Diseases; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Polyneuropathies; Treatment Outcome

Shingles is the cutaneous expression of the reactivation of latent varicella zoster virus infection in sensory ganglia. It presents as vesicles in the corresponding dermatome. The condition is called disseminated herpes zoster (DHZ) when more than 2 contiguous dermatomes are affected, more than 20 vesicles are observed outside the initial dermatome, or involvement is systemic. DHZ is rare and most frequently occurs in immunocompromised patients.. To describe the epidemiology, predisposing factors, clinical presentation, laboratory findings, and clinical course of patients with DHZ, and to compare the findings in immunocompromised and immunocompetent patients.. We analyzed a retrospective case series of adults hospitalized between February 2010 and October 2015.. Forty-one patients with virologically confirmed manifestations of DHZ were included. Stress as a trigger factor was detected in 39% and immunodepression in 58.5%. Immunocompromised patients were younger than the immunocompetent patients (mean ages, 60.5 vs 82 years, P<.01). The 8 immunocompetent patients with no detectable trigger factors were older (mean age, 85 years). In 95% of cases, DHZ was initially limited to a single dermatome and then spread to other dermatomes or became disseminated. Thrombocytopenia was detected in 56% of cases. Complication rates were similar in immunocompromised and immunocompetent patients (54% vs 59%, P>.01). Six patients died; there was no difference in mortality between the 2 groups.. This study provides evidence on the relationship between DHZ, the presence of underlying immunodepression, and complications. Immunosenescence may play an important role in the onset of this disease in older immunocompetent patients.

Topics: Acyclovir; Aged; Aged, 80 and over; Anemia; Antiviral Agents; Female; Herpes Zoster; Humans; Immunocompetence; Leukopenia; Male; Middle Aged; Neuralgia, Postherpetic; Retrospective Studies; Risk Factors; Spain; Stress, Psychological; Superinfection; Treatment Outcome

The epidemiology of herpes zoster (HZ) in contemporary autologous hematopoietic cell transplant (HCT) recipients, and the impact of acyclovir (ACV)/valacyclovir (VACV) prophylaxis, is not well described. In this observational study from 2002 to 2010, we retrospectively identified 1000 varicella zoster virus (VZV)-seropositive autologous HCT recipients with up to 5 years of follow-up. The incidence of HZ and use of ACV/VACV prophylaxis were determined through review of medical records and mailed questionnaires. Risk factors for HZ were determined by multivariable Cox regression. Over a period of 5 years after autologous HCT, 194 patients developed at least 1 HZ episode, with a cumulative incidence of 21%; 159 of 194 (82%) were not on prophylaxis at the time of HZ. A second episode of HZ occurred in 31 of 194 (16%) patients. Patients taking ACV/VACV had reduced risk for HZ (adjusted hazard ratio [aHR], .59; 95% confidence interval [CI], .37 to .91), whereas those older than the median age (≥55.5 years) had increased risk (aHR, 1.42; 95% CI, 1.05 to 1.9). Disseminated VZV was reported in 8% and postherpetic neuralgia in 13% of patients. We demonstrate a high burden of HZ late after autologous HCT, despite long-term antiviral prophylaxis. Improved prevention strategies are needed to provide sustained protection against HZ after autologous HCT.

Topics: Acyclovir; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Incidence; Male; Middle Aged; Neuralgia, Postherpetic; Premedication; Retrospective Studies; Risk Factors; Time Factors; Transplantation, Autologous; Valacyclovir; Valine

The purpose of this study was to develop a consensus regarding the appropriate regimen to evaluate long-term suppressive antiviral treatment to reduce complications from herpes zoster ophthalmicus (HZO) and identify potential study sites.. In January 2013, a survey of 13 questions was distributed among cornea fellowship directors, board members of the Cornea Society and Ocular Microbiology and Immunology Group, and Kera-net Listserv members. Questions identified respondents' preferred antiviral regimens to administer for chronic or recurrent HZO, gauged the level of interest in participation in a planned randomized clinical trial, and assessed the number of HZO patients treated among specialists in the past year.. Of the 171 respondents who completed the questionnaire, the majority identified as Kera-net Listserv members (107 of 171, 63%) and cornea fellowship directors (46 of 171, 27%). First choice of treatment was valacyclovir 500 mg 2 times per day (61 of 171, 36%), followed by acyclovir 800 mg 2 times per day (56 of 171, 33%), and then valacyclovir 1,000 mg daily (26.9%, 46 of 171). Among the choices, famciclovir consistently placed last among all the respondents (7 of 171, 4%). A majority (106 of 171, 62%) of all respondents, including 70% (26 of 37) of U. S. respondents of the high-volume practices, were interested in participating in a future randomized clinical trial evaluating whether treatment with oral antiviral medications for 1 year decreases complications of HZO.. This survey highlights the strong interest in and support for further study of suppressive antiviral treatment regimens to reduce complications of HZO.

Topics: 2-Aminopurine; Acyclovir; Adult; Antiviral Agents; Attitude of Health Personnel; Chronic Disease; Famciclovir; Female; Health Care Surveys; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Practice Patterns, Physicians'; Surveys and Questionnaires

Varicella zoster virus (VZV), a member of the human herpesvirus family, affects peripheral or cranial nerves and can reactivate years after the primary infection. Thymidine kinase (TK) is essential for VZV replication, and its active site is highly conserved in the herpesvirus family. A number of small-molecule inhibitors have already been successfully developed that target the TK of herpes simplex virus type 1 (HSV-1), which is one of the most prevalent sexually transmitted infections worldwide. In the present study, we attempted to test the sensitivities of HSV-1 TK inhibitors to their noncognate VZV TK by integrating in silico modeling and an in vitro assay. We tested nine representative HSV-1 TK inhibitors, including three FDA-approved drugs and six compounds that are under clinical development. The structures of the complexes of these inhibitor ligands with HSV-1 TK and noncognate VZV TK had been solved previously by X-ray crystallography or were modeled in the present work using a template-based approach. Subsequently, a rigorous quantum mechanics/molecular mechanics (QM/MM) nonbonded analysis that accounted for the Poisson-Boltzmann/surface area (PB/SA) solvent effect was employed to refine the complex structures and, on this basis, to evaluate the binding potencies of these complexes. As might be expected, the QM/MM-PB/SA-derived free energy was shown to be highly correlated with the HSV-1 TK inhibitory activities of the nine inhibitors. Further, it was found that the HSV-1 TK inhibitors exhibit strong binding affinities for their noncognate VZV TK, although they are still more selective for HSV-1 TK than for VZV TK. In order to test the theoretical results obtained from the computational analysis, we performed an in vitro kinase assay to determine the inhibitory potencies of three commercially available antiviral agents, namely penciclovir, ganciclovir, and aciclovir, against their noncognate target VZV TK, resulting in IC50 values of 86, 127, and 150 μM respectively, which are modestly weaker than the corresponding values obtained for HSV-1 TK. In addition, visual structure examination and virtual mutation/deletion analysis suggested that the residue Arg222 is present at the active site of HSV-1 TK but not at the active site of VZV TK, which is the reason for the difference in inhibitor selectivity between HSV-1 TK and VZV TK.

Topics: Acyclovir; Amino Acid Sequence; Antiviral Agents; Binding Sites; Computer-Aided Design; Drug Design; Enzyme Inhibitors; Ganciclovir; Guanine; Herpesvirus 1, Human; Herpesvirus 3, Human; Humans; Ligands; Molecular Docking Simulation; Molecular Sequence Data; Molecular Structure; Neuralgia, Postherpetic; Protein Binding; Protein Conformation; Structure-Activity Relationship; Thymidine Kinase; Viral Proteins

Mielitis cervicodorsal secundaria a infeccion por el virus varicela zoster en un paciente inmunocompetente.

Topics: Acyclovir; Antiviral Agents; Arm; Athetosis; Bromodeoxyuridine; Drug Therapy, Combination; Herpes Zoster; Herpesvirus 3, Human; Humans; Hyperalgesia; Immunocompetence; Male; Methylprednisolone; Middle Aged; Movement Disorders; Myelitis; Neck; Neuralgia, Postherpetic; Somatosensory Disorders; Thorax; Virus Activation

Post-herpetic neuralgia (PHN) is the most significant complication of herpes zoster caused by reactivation of latent Varicella-Zoster virus (VZV). We undertook a heterologous infection in vitro study to determine whether PHN-associated VZV isolates induce changes in sodium ion channel currents known to be associated with neuropathic pain. Twenty VZV isolates were studied blind from 11 PHN and 9 non-PHN subjects. Viruses were propagated in the MeWo cell line from which cell-free virus was harvested and applied to the ND7/23-Nav1.8 rat DRG x mouse neuroblastoma hybrid cell line which showed constitutive expression of the exogenous Nav 1.8, and endogenous expression of Nav 1.6 and Nav 1.7 genes all encoding sodium ion channels the dysregulation of which is associated with a range of neuropathic pain syndromes. After 72 hrs all three classes of VZV gene transcripts were detected in the absence of infectious virus. Single cell sodium ion channel recording was performed after 72 hr by voltage-clamping. PHN-associated VZV significantly increased sodium current amplitude in the cell line when compared with non-PHN VZV, wild-type (Dumas) or vaccine VZV strains ((POka, Merck and GSK). These sodium current increases were unaffected by acyclovir pre-treatment but were abolished by exposure to Tetrodotoxin (TTX) which blocks the TTX-sensitive fast Nav 1.6 and Nav 1.7 channels but not the TTX-resistant slow Nav 1.8 channel. PHN-associated VZV sodium current increases were therefore mediated in part by the Nav 1.6 and Nav 1.7 sodium ion channels. An additional observation was a modest increase in message levels of both Nav1.6 and Nav1.7 mRNA but not Nav 1.8 in PHN virally infected cells.

Topics: Acyclovir; Animals; Cell Line; Gene Expression Regulation; Herpes Zoster; Herpesvirus 3, Human; Humans; Mice; NAV1.6 Voltage-Gated Sodium Channel; NAV1.7 Voltage-Gated Sodium Channel; NAV1.8 Voltage-Gated Sodium Channel; Neuralgia, Postherpetic; Rats; Tetrodotoxin

Topics: Acyclovir; Amines; Analgesics; Antiviral Agents; Cyclohexanecarboxylic Acids; Female; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Male; Neuralgia, Postherpetic; Valine

Topics: Acyclovir; Adrenal Cortex Hormones; Anesthetics; Antiviral Agents; Herpes Zoster; Humans; Neuralgia, Postherpetic

There are no comparative data on the treatment duration of cutaneous herpes zoster (HZ) in patients with HIV infection. We retrospectively reviewed all 51 adult patients with HIV infection presenting with cutaneous HZ in the 15-year period 1995-2009 treated with intravenous aciclovir alone. The median CD4 count was 297 (range 10-703) cells/mm(3). There were 44 episodes of localized and seven episodes of disseminated cutaneous HZ. Patients received a median of nine (range 3-17) doses of intravenous aciclovir given at a median dose of 6.5 (range 2.9-10.8) mg/kg eight hourly. One patient (2%) relapsed early and four patients (7.8%) relapsed late with further episodes of cutaneous HZ. Seven patients (13.7%) developed postherpetic neuralgia. Three days of intravenous aciclovir is effective treatment for cutaneous HZ in patients with HIV infection.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; CD4 Lymphocyte Count; Female; Herpes Zoster; HIV Infections; Humans; Infusions, Intravenous; Male; Middle Aged; Neuralgia, Postherpetic; Recurrence; Retrospective Studies; Treatment Outcome

Topics: Acyclovir; Aged; Antiviral Agents; Exanthema; Female; Herpes Zoster; Herpes Zoster Vaccine; Humans; Male; Neuralgia, Postherpetic; Risk Factors; Spouses; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Female; Herpes Zoster; Humans; Middle Aged; Neuralgia, Postherpetic; Skin Care; Valacyclovir; Valine

To evaluate the efficacy of treatment with gabapentin plus valacyclovir hydrochloride for the prevention of postherpetic neuralgia in patients with acute herpes zoster.. Uncontrolled, open-label study.. A private dermatology clinic.. Consecutive immunocompetent adults (age, ≥ 50 years) who presented with herpes zoster within 72 hours of vesicle formation with moderate to severe pain (≥ 4 on the 10-point Likert scale) were recruited for study participation. Intervention The patients received 1000 mg of valacylovir hydrochloride 3 times a day for 7 days plus gabapentin at an initial dose of 300 mg/d, titrated up to a maximum of 3600 mg/d, side effects permitting.. Proportion of patients with zoster pain (pain > 0) at 3, 4, and 6 months as well as average pain severity, the proportion of patients with sleep disturbance, and quality-of-life measures (determined by the Medical Outcome Study Short Form 36-Item Health Survey).. A total of 133 patients (mean age, 64.6 years) were enrolled in the study. The overall incidence of zoster pain at 6 months was 9.8%.. The combination of gabapentin and valacyclovir administered acutely in patients with herpes zoster reduces the incidence of postherpetic neuralgia. Trial Registration clinicaltrials.gov Identifier: NCT01250561.

Topics: Acute Disease; Acyclovir; Aged; Amines; Analgesics; Antiviral Agents; Cyclohexanecarboxylic Acids; Drug Therapy, Combination; Female; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Incidence; Male; Middle Aged; Neuralgia, Postherpetic; Valacyclovir; Valine

Topics: Acyclovir; Amines; Analgesics; Antiviral Agents; Cyclohexanecarboxylic Acids; Female; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Male; Neuralgia, Postherpetic; Valacyclovir; Valine

We describe a woman who developed postherpetic neuralgia (PHN) located on the skin areas of the left ophthalmic division of the fifth cranial nerve without ocular involvement. PHN was associated with tinnitus, which was located ipsilaterally to the painful side and increased in proportion to the intensity of pain. Tinnitus was responsive to treatment with duloxetine, 60 mg daily, and subsided when the PHN resolved. This is the first description of tinnitus in PHN.

Topics: Acyclovir; Adrenergic Uptake Inhibitors; Aged; Antiviral Agents; Cranial Nerves; Duloxetine Hydrochloride; Female; Follow-Up Studies; Functional Laterality; Humans; Neuralgia, Postherpetic; Thiophenes; Tinnitus

Herpes zoster (HZ) is a common condition among older adults, manifested by pain and the classic presentation of a unilateral rash that follows a dermatomal distribution and does not cross the midline of the body. It is caused by reactivation of the virus that caused chickenpox during an earlier infection. In many cases, acute HZ is followed by a severe and disabling complication known as postherpetic neuralgia (PHN), characterized by pain that persists for months or even years after the HZ rash heals. Using an individual example, this article provides information on the clinical manifestations, evidence-based treatment recommendations for, and prevention of HZ and PHN through use of the zoster vaccine Zostavax, licensed in the United States in 2006.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Chest Pain; Female; Geriatric Nursing; Herpes Zoster; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Neuralgia, Postherpetic; Risk Factors; United States; Vaccination; Valacyclovir; Valine; Virus Activation

Topics: Acyclovir; Aged; Amines; Analgesics; Anti-Inflammatory Agents; Antiviral Agents; Cyclohexanecarboxylic Acids; Early Diagnosis; Female; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Magnetic Resonance Imaging; Methylprednisolone; Myelitis, Transverse; Neuralgia, Postherpetic; Paresthesia; Urinary Retention

To assess the incidence of and risk factors associated with postherpetic neuralgia (PHN) after hematopoietic cell transplantation (HCT) varicella zoster virus (VZV) infection, we conducted a retrospective chart review of 418 consecutive patients who underwent HCT between April 2005 and March 2007. The male/female ratio was 221/197, median age at HCT was 47 years (range: 0-69 years), and autologous/allogeneic/syngeneic HCT ratio was 154/263/1. Seventy-eight patients developed VZV infection after HCT. Sixty-two patients had localized zoster, 11 patients had disseminated zoster (rash like chicken pox), and 4 patients had visceral zoster. All cases were treated with acyclovir (ACV) or valacyclovir (VACV), and there was no VZV infection-related death. Twenty-seven (35%) of the 78 patients with VZV infection suffered PHN after resolution of VZV infection. Multivariate analysis showed that advanced age is the only risk factor in autologous HCT (P = .0075; odds ratio [OR] = 1.14; 95% confidence interval [CI], 0.97-1.33). On the other hand, advanced age (P = .0097; OR = 1.06; 95% CI, 1.01-1.12), male gender (P = .0055; OR = 12.7; 95% CI, 1.61-100.1), and graft-versus-host disease (GVHD) prophylaxis with a tacrolimus-based regimen (P = .0092; OR = 9.56; 95% CI, 1.44-63.3) were associated with increased risk of PHN in allogeneic HCT. This study for the first time clarified the risk of PHN in HCT recipients.

Topics: Acyclovir; Adolescent; Adult; Aged; Chickenpox; Child; Child, Preschool; Female; Genetic Diseases, Inborn; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Incidence; Infant; Infant, Newborn; Japan; Male; Middle Aged; Neoplasms; Neuralgia, Postherpetic; Postoperative Complications; Retrospective Studies; Risk; Transplantation, Autologous; Transplantation, Homologous; Valacyclovir; Valine; Virus Activation; Young Adult

To characterise predisposition to post herpetic neuralgia following herpes zoster.. Late follow up of patients originally admitted with acute zoster to a double blind randomised placebo controlled study of oral acyclovir over 60 years of age.. Two UK cities of 1.5 million population.. 158 of the 298 patients from the original study were available for evaluation at a mean follow up of 9 years. Thirty four (21%) described experiencing pain from the zoster within the previous 12 months. Pain at follow up was associated with characteristics at the time of acute zoster of: moderate or severe acute pain (p = 0.006), prodromal pain >72 h before rash (p = 0.006), severity of rash (p = 0.033) and female gender (p = 0.046). There was no association between pain at 9 year follow up and use of placebo or aciclovir nor with the presence or absence of pain at the point of discharge from the original study. Further analysis of 17 of the 34 patients with long term pain who have full data available, the median pain score was 4 out of 10 and more than 50% described persistent pain and interference with sleep.. Long term pain in the elderly following zoster is associated with identifiable characteristics during the acute illness.

Topics: Acyclovir; Aged; Aged, 80 and over; Causality; Female; Follow-Up Studies; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic; United Kingdom

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Neuralgia, Postherpetic; Valacyclovir; Valine

Herpes zoster (HZ) is a public health problem worldwide. Although, there is paucity of data of this disease from South American countries. The objective of this study was to evaluate clinical and epidemiological aspects of HZ in a population of patients from South America. We underwent a retrospective analysis of clinical charts of an infectious diseases reference center (period: 2000-2005). Univariate analysis was performed to assess variables related to post herpetic neuralgia (PHN). From a total of 302 cases, 62% were in women. The median age was 57 years: 16.1% of the patients had a predisposing condition for the development of HZ. Most frequent dermatomes involved were: thoracic, ophthalmic and lumbar; 93.5% of the patients received antiviral drugs and 94% complementary medications. The most frequent complication was PHN and was related with age over 50 years. Clinical and epidemiological aspects of HZ and the frequency of complications in our population were similar to data from developed countries.

Topics: Acyclovir; Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Analysis of Variance; Antiviral Agents; Argentina; Child; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Retrospective Studies; Young Adult

Topics: Acyclovir; Antiviral Agents; Drug Therapy, Combination; Female; Humans; Male; Neuralgia, Postherpetic; Valacyclovir; Valine