valacyclovir and Central-Nervous-System-Viral-Diseases

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

We retrospectively analyzed 80 instances of varicella zoster virus (VZV) disease in 72 patients who underwent allogeneic hematopoietic stem cell transplantation (HSCT) and examined the clinical differences between localized and disseminated disease. Risk factors for developing VZV dissemination were also evaluated.. Of the 80 instances, 54 instances were localized diseases and 26 were disseminated diseases. Patient characteristics did not differ significantly between the 2 groups, except for the first-line therapy and the duration from symptom onset to treatment. In the disseminated group, intravenous acyclovir was used as the first-line therapy more frequently, and more time elapsed before beginning antiviral therapy compared with the localized group. In multivariate analyses, the duration from symptom onset to treatment was identified as an independent risk factor that significantly affected the development of VZV dissemination. Gender, total body irradiation, and chronic graft-versus-host disease, of which the latter 2 factors were reported as risk factors for the development of VZV disease after HSCT, did not affect the development of VZV dissemination.. Our results suggest that VZV infection or reactivation may easily progress to viremia with delayed use of antiviral agents and may result in VZV dissemination in immunocompromised patients.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Central Nervous System Viral Diseases; Chickenpox; Disease-Free Survival; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Survival Rate; Time-to-Treatment; Valacyclovir; Valine; Virus Activation; Young Adult