A virologic pilot study of valacyclovir in infectious mononucleosis.
BACKGROUND
Infectious mononucleosis decreases the productivity of many college students and Epstein-Barr virus (EBV) infection may result in long-term immune damage.


OBJECTIVE
Evaluate the antiviral effect of valacyclovir during EBV-related acute infectious mononucleosis and explore potential clinical benefits.


METHODS
University students who presented during the first 7 days of illness were randomized to receive valacyclovir 3g/day for 14 days or not. The quantity of Epstein-Barr virus (EBV) DNA in oral and whole blood samples was determined by real-time (TaqMan) PCR. The primary outcome was the proportion of subjects with laboratory-confirmed primary EBV infection who had >or=2 log10 decrease in EBV copies/mL in oral washes during the treatment period. Secondary outcomes included clinical effects.


RESULTS
Twenty subjects were studied. The proportion of valacyclovir recipients versus control subjects who had >or=2 log10 decrease in EBV copies was significantly greater for both oral wash fluid-derived cell pellet (P=0.03) and supernatant (P=0.001) samples. At the end of the treatment period, the number of reported symptoms (P=0.03) and the severity of illness (P=0.049) were reduced among valacyclovir recipients as compared with controls.


CONCLUSIONS
Valacyclovir therapy caused a reduction of EBV excretion and possibly produced a clinical benefit in infectious mononucleosis. Because our study was small and not placebo-controlled, these results must be confirmed by a larger, placebo-controlled trial.
Balfour
Henry H
HH
Department of Laboratory Medicine & Pathology, University of Minnesota Medical Center, Minneapolis, MN, USA. balfo001@umn.edu
Hokanson
Kristin M
KM
Schacherer
Robyn M
RM
Fietzer
Christine M
CM
Schmeling
David O
DO
Holman
Carol J
CJ
Vezina
Heather E
HE
Brundage
Richard C
RC
D000212:Acyclovir / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000293:Adolescent; D000328:Adult; D001483:Base Sequence; D005260:Female; D004854:Herpesvirus 4, Human / Q000254:growth & development*; D006801:Humans; D007244:Infectious Mononucleosis / Q000188:drug therapy* / Q000821:virology; D008297:Male; D008969:Molecular Sequence Data; D009055:Mouth / Q000821:virology; D010865:Pilot Projects; D016133:Polymerase Chain Reaction / Q000379:methods; D000077483:Valacyclovir; D014633:Valine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir