valacyclovir and Acquired-Immunodeficiency-Syndrome

Herpes simplex virus (HSV) infections are among the infections most frequently encountered by humans. Two types of HSV infections have been identified-HSV-1, which usually causes orolabial disease, and HSV-2, which is associated more frequently with genital and newborn infections. Usually, HSV causes mild and self-limited disease of the mouth and lips or at genital sites. However, on occasion, the disease can be life-threatening. Such is the case with neonatal HSV infection and HSV infections of the central nervous system. Furthermore, in the immunocompromised host, severe infection has been encountered and is a source of morbidity. Even in the immunocompetent host, frequent recurrences, particularly those of the genital tract, can be debilitating. Because HSV does cause genital ulcerative disease, it is associated with an increased risk of acquiring a human immunodeficiency virus infection. During the past 2 decades, selective and specific inhibitors of HSV replication have been developed. These agents, acyclovir, valaciclovir, and famciclovir, all accelerate the events of healing and decrease the probability of excreting the virus when they are taken in a suppressive fashion. The long-term safety of acyclovir has been unequivocally established. Its prodrug, valaciclovir, and the prodrug of penciclovir, famciclovir, have not been used in practice as long and, therefore, less is known about these agents; however, neither is available as a pediatric formulation.

Topics: 2-Aminopurine; Acquired Immunodeficiency Syndrome; Acyclovir; Administration, Oral; Adult; Antiviral Agents; Central Nervous System Viral Diseases; Child, Preschool; Drug Resistance, Viral; Famciclovir; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Infant; Infant, Newborn; Injections, Intravenous; Simplexvirus; Valacyclovir; Valine; Virus Replication

Controlled trials suggest that acyclovir/valacyclovir can provide significant clinical benefits when used for prophylaxis in the immunocompromised host. These findings implicate herpesvirus(es) in the pathogenesis of complex medical conditions, including graft rejection and death. However, it is not known which of the 8 herpesviruses are important under particular circumstances. Prime candidates for triggering adverse outcomes are cytomegalovirus (CMV) in solid organ transplant recipients (causing rejection), CMV and human herpesvirus type 6 (HHV-6) in bone marrow transplant patients (causing marrow suppression), and herpes simplex virus, HHV-6, and CMV in AIDS patients (accelerating the rate of human immunodeficiency virus disease progression and death). Other diseases that may have a herpesvirus component or trigger susceptible antiviral agents include atherosclerosis and multiple sclerosis. In the future, clinicians should be alert to novel findings of randomized trials that may provide insight into the pathogenesis of these diseases and the contributions made by clinically silent herpesvirus infections.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Arteriosclerosis; Bone Marrow Transplantation; Clinical Trials as Topic; Disease Progression; Herpesviridae; Herpesviridae Infections; Humans; Multiple Sclerosis; Organ Transplantation; Postoperative Complications; Valacyclovir; Valine

Kaposi varicelliform eruption (KVE) is a cutaneous dissemination of a viral infection, which is mostly caused by herpes simplex virus (HSV) in the setting of certain underlying skin diseases. KVE occurs mainly in infants and children, but very rarely in adults. Here, we report a case of KVE with contact dermatitis in a 36-year-old man with acquired immunodeficiency syndrome (AIDS), who was referred to our deparment with pruritic well-defined facial erythema and multiple vesicular lesions. A punch biopsy and immunohistochemical examination established the diagnosis of KVE with contact dermatitis. After treatment with valacyclovir and antihistamines, facial lesions achieved complete remission. With this case report, KVE has specific manifestation in clinic, histopathology and immunohistochemistry, which could guide the early diagnosis and improve prognosis.

Topics: Acquired Immunodeficiency Syndrome; Adult; Child; Dermatitis, Contact; Herpes Simplex; Humans; Infant; Kaposi Varicelliform Eruption; Male; Valacyclovir

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Anti-Infective Agents, Local; Antiviral Agents; Foot Ulcer; Herpesvirus 1, Human; Humans; Male; Middle Aged; Treatment Outcome; Valacyclovir; Valine

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

In persons with AIDS (PWAs), cytomegalovirus (CMV) infection can cause a broad spectrum of clinical manifestations. The most common clinical manifestations associated with CMV infection in PWAs and the most current approaches to treatment and prevention of CMV disease are reviewed. Manifestations discussed include those involving ocular disease, and diseases of the gastrointestinal and central nervous systems. Prophylactic treatment for CMV disease includes the use of oral ganciclovir and valaciclovir. Concluding comments address the development of antiviral resistance by CMV. Tables include listings of potential strategies for use of oral ganciclovir prophylaxis in PWAs, and mechanisms by which CMV strains become resistant to ganciclovir, foscarnet, and cidofovir.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Antiviral Agents; Central Nervous System Diseases; Cytomegalovirus Infections; Cytomegalovirus Retinitis; Digestive System Diseases; Foscarnet; Ganciclovir; Humans; Valacyclovir; Valine