title: Studies in the prophylaxis of herpes infections in severely immunocompromised patients using acyclovir.
abstract: That acyclovir is effective therapeutically in herpes simplex virus (HSV) and herpes zoster (VZV) infections in immunocompromised patients has been established [13]. This paper reviews our subsequent studies in prophylaxis of herpes group infections in a high risk group of patients suffering from acute leukaemia. In study 1 we randomised HSV seropositive (greater than or equal to 1:8) patients to receive intravenous acyclovir or placebo. In this stratified study bone marrow transplant (BMT) recipients were completely protected from HSV infections by acyclovir compared with a 50% failure rate for those on placebo. There was significant protection also in the non-BMT group [8]. In study 2 oral acyclovir prophylaxis failed to provide complete protection in BMT recipients despite the achievement of apparently adequate blood levels. In study 1 the secretion of EBV in saliva before and during the trial gave inconclusive results. In each of the first two studies one patient on "active" acyclovir developed a cytomegalovirus (CMV) infection. Thus, at the dosage of drug used, prophylaxis of CMV was unsuccessful suggesting that claims of therapeutic efficacy are unlikely to be supported in controlled trials. Study 3 is current and concerns the pharmacokinetics of an acyclovir prodrug (BW 134U) taken by mouth. This drug is near 100% absorbed and achieves approximately twice the level of active acyclovir in vivo, following conversion by adenosine deaminase (ADA), in normal volunteers.
mesh_terms: D000212:Acyclovir / Q000009:adverse effects / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002986:Clinical Trials as Topic; D006561:Herpes Simplex / Q000150:complications / Q000517:prevention & control*; D006562:Herpes Zoster / Q000150:complications / Q000517:prevention & control*; D006801:Humans; D007109:Immunity; D007938:Leukemia / Q000150:complications / Q000276:immunology; D009503:Neutropenia / Q000150:complications
chemical_list: D000212:Acyclovir