valacyclovir and AIDS-Related-Opportunistic-Infections

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Anti-Infective Agents; Antitubercular Agents; Antiviral Agents; Atovaquone; Azithromycin; Chickenpox; Clarithromycin; Cytomegalovirus Infections; Drug Therapy, Combination; Ganciclovir; Herpes Simplex; Humans; Mycobacterium avium-intracellulare Infection; Naphthoquinones; Pneumonia, Pneumocystis; Rifabutin; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Antifungal Agents; Antiprotozoal Agents; Antiretroviral Therapy, Highly Active; Antitubercular Agents; Antiviral Agents; Atovaquone; Azithromycin; Clarithromycin; Cytomegalovirus Infections; Drug Therapy, Combination; Famciclovir; Herpes Simplex; Herpes Zoster; Humans; Mycobacterium avium-intracellulare Infection; Mycoses; Naphthoquinones; Pneumonia, Pneumocystis; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary; Valacyclovir; Valine

Treatment of genital herpes requires accurate diagnosis, patient support, and effective treatment. Diagnosis is usually straightforward for classic presentations characterized by vesicular lesions but can be challenging for atypical presentations, which are more common. Diagnosis of asymptomatic infection requires access to molecular technology or type-specific serologic assays. Misconceptions about herpes simplex infection are common and patient education is essential. Patient concerns extend beyond disease frequency and severity-the psychological impact should not be underestimated. Antiviral therapy is relevant at all stages of infection. Acyclovir, valacyclovir, and famciclovir are effective and well tolerated for genital herpes treatment. Continuous suppressive therapy controls all symptoms of recurrent disease and helps to relieve disease complications. The prodrugs valacyclovir and famciclovir offer easier, less-frequent dosing than required for acyclovir. Valacyclovir achieves effective suppression when taken once a day. Interventions to prevent genital herpes transmission and to control the global problem are urgently required.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antibodies, Viral; Antiviral Agents; Chronic Disease; Clinical Trials as Topic; Dose-Response Relationship, Drug; Famciclovir; Herpes Genitalis; Herpesvirus 1, Human; Herpesvirus 2, Human; HIV Infections; Humans; Immunocompetence; Patient Education as Topic; Prodrugs; Secondary Prevention; Treatment Outcome; Valacyclovir; Valine

We report a case of a 28-year-old human immunodeficiency virus-positive man. He presented with confluent verrucous papules and nodules on his scrotum that were due to herpes simplex infection.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Diagnosis, Differential; Herpes Genitalis; Humans; Male; Scrotum; Valacyclovir; Valine

Human cytomegalovirus (HCMV) infects about 60% of adults in developed world and more than 90% of developing countries population. In the immunocompetent host, initial infection and reactivation of latent infection are usually asymptomatic. However, in hosts with impaired cellular immune functions, such as transplant recipients, patients infected with human immunodeficiency virus (HIV) or undergoing anticancer chemo- and/or radiotherapy, the full pathogenic potential of the virus may be realized. HCMV is also among the most common causes of viral intrauterine infection affecting from 0.4 to 2.3% of live-born infants. Though in pregnant, immunocompetent women infections with HCMV are usually asymptomatic, severe infections may occur among congenitally infected fetuses and infants due to immaturity of their immune system. Approximately 40% of mothers with primary HCMV infections during gestation transmit virus to their infants. Although only 10% of infected infants are symptomatic at birth, 20 to 30% of these die. In addition, 5 to 15% of asymptomatic neonates are at risk of developing congenital anomalies later. In this outline we present anti-CMV drugs currently in clinical use and give examples of new molecules under laboratory and clinical development.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Antiviral Agents; Cidofovir; Cytomegalovirus Infections; Cytosine; Drugs, Investigational; Female; Foscarnet; Ganciclovir; Global Health; Humans; Infectious Disease Transmission, Vertical; Naphthalenesulfonates; Organophosphonates; Organophosphorus Compounds; Pregnancy; Pregnancy Complications, Infectious; Thionucleotides; Valacyclovir; Valganciclovir; Valine

Viral lesions of the mouth in patients with HIV infection are common and these diseases any be a marker for HIV and disease progression. We review the spectrum of oral viral manifestations and discuss treatment modalities. The most common Epstein-Barr virus (EBV)-induced disorder in HIV-infected patients is oral hairy leukoplakia. EBV-related oral B-cell and T-cell lymphoma in AIDS patients has been described repeatedly. Herpes virus type 1 and rarely type 2 may lead to painful and resistant oral ulcers, and systemic treatment with acyclovir, valaciclovir or famciclovir is indicated. In acyclovir-resistant cases foscarnet is the treatment of choice. In recent years it has been documented that Kaposi's sarcoma, which often affects oral mucosa, is probably induced by herpesvirus type 8. Cytomegalovirus was found in 53% of cases with herpesviridae-induced mucosal ulcers as the only ulcerogenic viral agent in AIDS patients. In severe cytomegalovirus infection treatment with ganciclovir is helpful. Viral warts induced by different HPV may occur in the mouth. Several physical treatment modalities are possible in the oral mucosa. In AIDS patients mollusca contagiosa may occur as large and atypical lesions in the face and lips and rarely in the oral cavity. Cryotherapy is a bloodless treatment in such patients.

Topics: 2-Aminopurine; Acyclovir; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Cytomegalovirus Infections; Disease Progression; Famciclovir; Foscarnet; Ganciclovir; Herpesviridae Infections; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 4, Human; Herpesvirus 8, Human; Humans; Leukoplakia, Hairy; Lymphoma, B-Cell; Lymphoma, T-Cell; Molluscum Contagiosum; Mouth Diseases; Mouth Neoplasms; Oral Ulcer; Prodrugs; Sarcoma, Kaposi; Stomatitis, Herpetic; Tumor Virus Infections; Valacyclovir; Valine; Virus Diseases; Warts

More than 90% of patients with HIV have been infected at some time with cytomegalovirus (CMV) and up to 40% of those with advanced HIV will develop CMV disease. The incidence of CMV disease is increasing but the prognosis for the patient remains poor.. It is therefore important to monitor patients with low CD4+ counts in order to identify those most at risk of developing CMV disease and to treat them before the disease becomes established. Polymerase chain reaction (PCR) is probably the most effective and sensitive method of detecting CMV and a positive result is predictive for development of CMV disease; more than 80% of patients with CMV retinitis are CMV PCR-positive at the time of diagnosis. PCR can also detect the presence of CMV up to 14 months before the development of retinitis.. In patients with detectable CMV, but no evidence of active infection, pre-emptive treatment with ganciclovir or valaciclovir has been shown to reduce the risk of developing retinitis in these high-risk patients. Such oral therapy, which is generally better tolerated than intravenous therapy and results in a better quality of life for the patient, is likely to be more effective at this stage whilst viral loads are low.. CMV PCR can be used to prospectively monitor patients in order to identify those most at risk of developing CMV retinitis. If CMV infection is diagnosed early, while viral loads are still low, pre-emptive oral therapy can be instituted which will reduce the chances of developing retinitis in those patients most at risk.

Topics: Acyclovir; Administration, Oral; AIDS-Related Opportunistic Infections; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Cytomegalovirus Retinitis; Ganciclovir; Humans; Polymerase Chain Reaction; Risk Factors; Valacyclovir; Valine

Human herpesvirus-8 (HHV-8) replication is a key factor in Kaposi sarcoma, primary effusion lymphoma, and Castleman disease pathogenesis. In vitro data suggest that antivirals inhibit HHV-8 replication, but little data exist in humans. Daily oropharyngeal swabs were analyzed from HIV/HHV-8 dually infected men enrolled in three previous clinical trials of valacyclovir and famciclovir for HIV-1 and/or HSV-2 suppression. Fifty-eight participants contributed 6,036 swabs. HHV-8 was detected in 1,128 (19%) of 6,036 swabs, including 618 (21%) of 2,992 on placebo, 323 (15%) of 2,221 on valacyclovir, and 187 (23%) of 823 on famciclovir. After adjusting for baseline HIV viral load and highly active antiretroviral therapy (HAART) use, an 18% reduction in HHV-8 shedding frequency (IRR 0.822; P = 0.011) was found in participants on valacyclovir and a 30% reduction (IRR 0.700; P < 0.001) on famciclovir. HAART was associated with an 89% (IRR 0.129; P = 0.048) reduction in HHV-8-shedding. Neither antiviral nor antiretroviral therapy was associated with decreased HHV-8 quantity. Valacyclovir and famciclovir were associated with modest but significant reductions in HHV-8 oropharyngeal shedding frequency. In contrast, HAART was a potent inhibitor of HHV-8 replication. Studies of whether antiviral therapy in combination with ART will prevent HHV-8-associated disease appear warranted.

Topics: 2-Aminopurine; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Antiviral Agents; Famciclovir; Herpesviridae Infections; Herpesvirus 8, Human; HIV-1; Humans; Male; Middle Aged; Oropharynx; Valacyclovir; Valine; Viral Load; Virus Replication

Epstein-Barr virus (EBV) replicates productively in oral hairy leukoplakia (HLP). One characteristic of human immunodeficiency virus (HIV)-associated HLP is a decreased oral epithelial Langerhans cell count. This prospective study tested the hypothesis that oral epithelial EBV replication decreases oral Langerhans cell counts. EBV replication in HLP was highly correlated with decreased oral Langerhans cell counts. Inhibition of EBV replication restored oral Langerhans cell counts to normal control levels, and the return of EBV replication after treatment resulted in a recurrent decline in oral Langerhans cell counts. Decreased oral Langerhans cell counts occurred independently of HIV infection, as demonstrated in HLP of otherwise healthy HIV-seronegative individuals. These results support the tested hypothesis and suggest that EBV manipulates and evades the mucosal immune response in oral epithelial infection. This novel EBV strategy for eliminating oral Langerhans cells may facilitate the persistence of oral epithelial EBV and may contribute to the pathogenesis of HLP.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cell Count; Herpesvirus 4, Human; HIV Infections; Humans; Langerhans Cells; Leukoplakia, Hairy; Male; Middle Aged; Mouth; Valacyclovir; Valine; Virus Replication

Our objective was to evaluate valaciclovir for anogenital herpes in HIV-infected individuals using 2 controlled trials conducted before highly active antiretroviral therapy (HAART) was used. In Study 1, 1062 patients (CD4+ > or = 100 cells/mm(3)) received suppressive valaciclovir or aciclovir for one year and were assessed monthly. In Study 2, 467 patients were treated episodically for > or =5 days with valaciclovir or aciclovir and evaluated daily. Valaciclovir was as effective as aciclovir for suppression and episodic treatment of herpes. Hazard ratios [95% confidence interval (CI)] for time to recurrence for valaciclovir 500 mg twice daily and 1000 mg once daily vs aciclovir were 0.73[0.50, 1.06], P=0.10, and 1.31[0.94, 1.82], P=0.11. Valaciclovir 500 mg twice daily was superior to 1000 mg once daily, P=0.001. Valaciclovir 1000 mg twice daily was comparable to aciclovir on herpes episode duration (hazard ratio 0.92[0.75, 1.14]). Adverse events were similar among treatments. In conclusion, valaciclovir is a safe, effective, convenient alternative to aciclovir for HSV infection in HIV-infected individuals.

Topics: Acyclovir; Adult; Aged; AIDS-Related Opportunistic Infections; Antiviral Agents; Confidence Intervals; Double-Blind Method; Drug Administration Schedule; Female; Herpes Genitalis; HIV Infections; Humans; Male; Middle Aged; Recurrence; Simplexvirus; Treatment Outcome; Valacyclovir; Valine

Cytomegalovirus (CMV) disease is a common complication of patients with advanced human immunodeficiency virus infection. The aim of the present study, based on a case-cohort design, was to determine the predictive value of follow-up and baseline qualitative plasma CMV polymerase chain reaction (PCR) values for CMV end-organ disease in 378 patients (158 who progressed to CMV end-organ disease and 220 who did not develop CMV disease). These patients are part of the full AIDS Clinical Trials Group 204 multinational study (1227 patients), a randomized, controlled trial that compared the effects of valacyclovir with those of acyclovir for CMV disease prevention. Baseline PCR positivity was a significant risk factor for CMV disease progression (relative risk [RR], 1.81; 95% confidence interval [CI], 1.09-3.00). In multivariate analyses, time-updated PCR positivity was strongly associated with progression to CMV end-organ disease (RR, 4.42; 95% CI, 2.87-6.81). Change in cumulative PCR status was informative for the risk of subsequent CMV disease.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Case-Control Studies; Cytomegalovirus; Cytomegalovirus Infections; HIV Infections; Humans; Male; Multivariate Analysis; Polymerase Chain Reaction; Predictive Value of Tests; Risk Factors; Valacyclovir; Valine

Virus load is a major risk factor for disease in many human viral infections, especially human immunodeficiency virus (HIV) disease. The effect of cytomegalovirus (CMV) load on disease progression and the influence of antiviral chemotherapy on surrogate markers of replication was investigated in 310 patients with advanced HIV disease in a randomized controlled trial that compared the effects of valacyclovir with those of acyclovir. Sequential blood and urine samples were analyzed by polymerase chain reaction (PCR), for human CMV (HCMV) DNA. In multivariate analyses, elevated virus load in both blood and urine at baseline was associated with increased risk of HCMV disease (relative hazard, 1.49 and 1.44 per log increase, respectively). Elevated virus load in blood at baseline was also associated with a significantly shorter survival time (log rank, P=. 0001). In time-updated analyses, valacyclovir significantly suppressed the virus load in subjects who were PCR positive at baseline (in blood or urine), when compared with the combined acyclovir arms.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Analysis of Variance; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Disease-Free Survival; HIV Infections; Humans; Multivariate Analysis; Polymerase Chain Reaction; Prodrugs; Risk Factors; Survival Rate; Time Factors; Valacyclovir; Valine; Virus Replication

Cytomegalovirus (CMV) disease is a common complication of advanced human immunodeficiency virus (HIV) infection. Administration of oral valaciclovir, a valine ester of acyclovir, achieves sufficient plasma acyclovir levels to inhibit many clinical isolates. Acyclovir has been associated with enhanced survival in AIDS but not with CMV disease prevention. CMV-seropositive patients (1227) with CD4 cell counts <100/mm3 were enrolled in a randomized, double-blind trial. Valaciclovir, 8 g/day, was compared with acyclovir, 3.2 or 0.8 g/day, for CMV prevention; all three arms were compared for survival. The confirmed CMV disease rate was 11.7% among valaciclovir recipients and 17.5% in the pooled acyclovir arms, a 33% reduction in risk. Time to confirmed CMV disease was significantly longer for the valaciclovir group (P = .03). A trend toward earlier mortality for valaciclovir recipients was seen (P = .06). Toxicity and earlier medication discontinuation were more common in this group. Valaciclovir significantly reduces the risk of CMV disease. Further exploration of a better-tolerated dose is warranted.

Topics: Acyclovir; Administration, Oral; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; CD4 Lymphocyte Count; Cytomegalovirus Infections; Double-Blind Method; Female; Humans; Male; Valacyclovir; Valine

Samples of blood and urine were collected at baseline, week 4, and week 8 and then every 8 weeks from 310 patients entering a controlled trial of prophylaxis with valaciclovir versus acyclovir. Samples were tested under code by polymerase chain reaction (PCR) in one laboratory. The median number of samples collected from each patient was 5 for blood (range, 0-15) and 5 for urine (range, 0-15). Both baseline PCR viremia and PCR viruria were significantly associated with future cytomegalovirus (CMV) disease (P = .002 and P = .02, respectively). The greatest effect of valaciclovir on CMV disease was seen in patients who were PCR-positive in blood at baseline (P = .002), although a significant effect was also seen in those who were PCR-negative in urine (P = .02). Thus, PCR viremia provides prognostic information about CMV disease in AIDS patients, and valaciclovir showed activity as both a preemptive and prophylactic agent.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; CD4 Lymphocyte Count; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Double-Blind Method; Female; Humans; Male; Multivariate Analysis; Polymerase Chain Reaction; Prognosis; Valacyclovir; Valine; Viremia

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cytomegalovirus Infections; Double-Blind Method; Hemolytic-Uremic Syndrome; HIV Infections; Humans; Male; Middle Aged; Prodrugs; Prospective Studies; Purpura, Thrombotic Thrombocytopenic; Risk Factors; Valacyclovir; Valine

A study (ACTG 204) involving the effect of valacyclovir in preventing CMV disease in persons with advanced HIV infection (CD4 count under 100) was stopped because there were more deaths in the valacyclovir arm than in either (high dose/low dose) acyclovir arms of the study. There is no obvious explanation. It is believed the high doses of valacyclovir used were too high for this patient population; this may have led to side effects and resulting breaks in treatment that could have adversely affected survival. A greater survival effect may have been seen with acyclovir due to greater time on treatment, or greater consistency of treatment. However, two studies presented at the Human Retroviruses conference in Washington, D.C. failed to find a survival benefit of acyclovir. Further investigation into ACTG 204's design and findings are underway.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; CD4 Lymphocyte Count; Cytomegalovirus Infections; Dose-Response Relationship, Drug; Ethics, Medical; Humans; Placebos; Survival Analysis; Valacyclovir; Valine

HIV-related treatment and prevention strategies for opportunistic infections presented at the 1995 International Conference on Antimicrobial Agents and Chemotherapy (ICAAC) are highlighted. Research highlights include valaciclovir for CMV prophylaxis, oral ganciclovir for preventing CMV, resistant CMV, and cidofovir (HPMPC) for CMV. Other topics discuss treatments of Mycobacterium avium complex, opportunistic infections and HIV viremia; and reports on the effects of influenza and pneumococcal immunizations on HIV viral load.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Antiviral Agents; Bacterial Vaccines; CD4 Lymphocyte Count; Cidofovir; Clinical Trials as Topic; Cytomegalovirus Infections; Cytosine; Drug Resistance, Microbial; Ganciclovir; HIV; Humans; Influenza Vaccines; Mycobacterium avium-intracellulare Infection; Organophosphonates; Organophosphorus Compounds; Pneumonia; Pneumonia, Pneumocystis; Randomized Controlled Trials as Topic; United States; Valacyclovir; Valine; Viremia

Questions are being raised about the efficacy of oral ganciclovir (Cytovene) in preventing cytomegalovirus (CMV), and the toxicity of valaciclovir, a derivative of acyclovir, when administered in high doses. Two government studies (Syntex 1654 and CPCRA 023) of oral ganciclovir have resulted in conflicting results. The studies are under investigation in an attempt to resolve the differences. CPCRA has led to concerns about Cytovene, including its potential for resistance and its relatively high cost. Another study shows two grams of valaciclovir, four times per day, produces the same blood levels as intravenous acyclovir. However, both are toxic levels and neither drug is viewed as particularly effective.

Topics: Acyclovir; Administration, Oral; AIDS-Related Opportunistic Infections; Antiviral Agents; CD4 Lymphocyte Count; Cytomegalovirus Infections; Cytomegalovirus Retinitis; Ganciclovir; Humans; Placebos; Randomized Controlled Trials as Topic; Treatment Outcome; Valacyclovir; Valine

Topics: Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Herpes Genitalis; Herpesvirus 2, Human; Humans; Immunocompromised Host; Male; Perineum; Skin Ulcer; Valacyclovir

To report a case of progressive outer retinal necrosis (PORN) presenting as a cherry red spot.. Case report.. A 53-year-old woman with recently diagnosed HIV and varicella-zoster virus (VZV) aseptic meningitis developed rapid sequential vision loss in both eyes over 2 months. Her exam showed a "cherry red spot" in both maculae with peripheral atrophy and pigmentary changes, consistent with PORN. Due to her late presentation and the rapid progression of her condition, she quickly developed end-stage vision loss in both eyes.. PORN should be considered within the differential diagnosis of a "cherry red spot." Immune-deficient patients with a history of herpetic infection who present with visual loss warrant prompt ophthalmological evaluation.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Antiviral Agents; Blindness; Disease Progression; Eye Infections, Viral; Female; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Mucolipidoses; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine

Genital herpes, a viral infection caused by Herpes simplex virus (HSV), is the most common cause of genital ulceration. Patients with a severe decrease in cellular immunity, such as patients positive for Human immunodeficiency virus (HIV) infection, are more likely to develop atypical, severe, disseminated and/or chronic HSV infections. On the other hand, there is an increase incidence of HIV detection among patients positive for HSV infection, as genital ulcers represent a potential portal of entry of HIV into the host. A case of a 52-year-old homosexual man with a two-month history of multiple erythematous ulcerative lesions on the perianal area, the buttocks, and the third left finger is presented. According to the clinical history, the clinical findings and the laboratory results, a diagnosis of HSV infection was made and treatment with valaciclovir was started, which led to complete regression of lesions 30 days later. The atypical features of the herpetic lesions, along with a past history of atypical pneumonitis one year prior to our observation, prompted to a diagnosis of concurrent HIV infection, later confirmed by laboratory. Atypical and disseminated HSV infections occur relatively often in HIV+ patients. This article discusses clinical presentation, diagnosis and management of HSV infection in such cases.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Anal Canal; Antiviral Agents; Buttocks; Fingers; Herpes Genitalis; HIV Seropositivity; HIV-1; Homosexuality, Male; Humans; Immunocompromised Host; Male; Middle Aged; Valacyclovir; Valine

We reviewed retrospectively the demographic, clinical, biological characteristics and outcomes of 11 patients with HSV meningitis.. Among the 11 patients, six were infected with HIV, four had a documented history of genital herpes, and one recurrent meningitis. In all cases, the onset of symptoms was abrupt, with severe headache and fever. On admission, 9/11 patients had severe meningismus; two patients had HSV anogenital ulcerations. CSF analysis showed in every case a significant increased of leukocytes with a lymphocytic pleocytosis, a mild elevated protein level and a normal glucose level. HSV was detected in the CSF in every case by PCR: the typing performed on six patients was positive in every case for HSV-2. Intravenous acyclovir (IV ACV) was started in 10/11 cases (range: 3-10 days), switched to valaciclovir (VACV) (range: 5-7 days); one patient was treated with ACV per os for 10 days. The total resolution of symptoms occurred within 48hours in every case. Two patients presented with recurrent HSV-2 meningitis in the next two months, with favorable outcome under IV ACV: a switch to long term VACV 500mg/day was prescribed without any recurrence. No patient presented with recurrence after a median follow-up of 30 months.. Early recognition and treatment might improve the outcome of such infections. Adjunctive oral VACV after IV ACV treatment seems to be associated with a good clinical response in patients presenting with HSV meningitis. The duration of such treatments, including prophylactic treatments to prevent recurrent episodes must be better documented.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Comorbidity; Disease Susceptibility; Encephalitis, Herpes Simplex; Female; Herpes Genitalis; Herpesvirus 2, Human; Hospitals, Urban; Humans; Male; Middle Aged; Paris; Recurrence; Retrospective Studies; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Herpes Genitalis; HIV Seropositivity; Humans; Male; Postoperative Care; Treatment Outcome; Valacyclovir; Valine; Viral Load

Topics: Acyclovir; Adrenal Cortex Hormones; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Diagnosis, Differential; Female; Herpes Genitalis; Humans; Middle Aged; Valacyclovir; Valine; Viral Load

Whereas valacyclovir is widely used and is recommended by some authors in moderately immunocompromised HIV-infected patients, its use has not been validated by clinical studies. We report a case of herpes zoster in an HIV-infected patient for whom neurologic complication was not avoided despite valacyclovir therapy. Clinical outcome was favorable after intravenous acyclovir. This case suggests careful monitoring of valacyclovir in HIV-infected patients is necessary.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Antiviral Agents; CD4 Lymphocyte Count; Drug Monitoring; Electromyography; Herpes Zoster; Humans; Immunocompromised Host; Infusions, Intravenous; Male; Middle Aged; Patient Selection; Radiculopathy; Treatment Failure; Valacyclovir; Valine; Viral Load

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Antiviral Agents; HIV-1; Humans; Keratitis, Herpetic; Male; Middle Aged; Prodrugs; Purpura, Thrombotic Thrombocytopenic; Recurrence; Valacyclovir; Valine

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; AIDS-Related Opportunistic Infections; Antiviral Agents; Biological Availability; CD4 Lymphocyte Count; Drug Resistance, Microbial; Famciclovir; Herpes Zoster; Humans; Valacyclovir; Valine

Results of a study of high-dosage (8 g/day) valaciclovir and its relation to cytomegalovirus (CMV) disease show that 15 percent of subjects developed complications of CMV disease. Although some subjects developed CMV disease (12 percent) during valaciclovir treatment, the study reveals that there was an overall 33 percent reduction in the development of CMV in people using the drug. Gastrointestinal complaints occurred more often and earlier with subjects using valaciclovir rather than acyclovir. Also, signs of thrombotic microangiopathy occurred significantly more often in valaciclovir users versus acyclovir users. Reduced survival rates compared to acyclovir were noted, although this could be a result of too high of a dose of valaciclovir being administered.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; CD4 Lymphocyte Count; Cytomegalovirus Infections; Dose-Response Relationship, Drug; Female; Humans; Male; Valacyclovir; Valine

As more drugs are approved for the prevention of opportunistic infections, concerns regarding the benefits and potential risks of these therapies are arising. A synopsis of the data for prophylaxis against opportunistic infections is provided for the following: Pneumocystis carinii pneumonia, fungal infections, Mycobacterium avium complex, cytomegalovirus infections, and toxoplasmosis. General precautions in using preventive medications for people with fewer than 100 CD4 plus cells are highlighted.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Clarithromycin; Clindamycin; Clinical Trials as Topic; Clotrimazole; Cytomegalovirus Infections; Dapsone; Fluconazole; Ganciclovir; Humans; Itraconazole; Leucovorin; Mycobacterium avium-intracellulare Infection; Mycoses; Pentamidine; Pneumonia, Pneumocystis; Pyrimethamine; Rifabutin; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination; Valacyclovir; Valine