Viremia in acute herpes zoster.
BACKGROUND
A phase 2 trial was conducted to evaluate the efficacy of a topical antiviral, sorivudine, as an adjuvant to valacyclovir for the treatment of acute herpes zoster.


METHODS
In this randomized, placebo-controlled, double-blind trial, 25 patients were treated with either sorivudine or placebo cream. All patients began 7 days of valacyclovir treatment on day 3. Zoster lesion swab samples and samples of peripheral blood mononuclear cells were collected periodically throughout the study and were analyzed for varicella-zoster virus (VZV) DNA by use of both qualitative and real-time polymerase chain reaction. Serum samples collected periodically throughout the study were analyzed for VZV DNA by use of real-time polymerase chain reaction.


RESULTS
VZV DNA was detected in all 3 sample types, and the number of viral copies correlated with the progression of herpes zoster. No statistically significant differences were seen between the placebo- and sorivudine-treated groups with respect to clinical characteristics or laboratory test results.


CONCLUSIONS
The detection of VZV DNA in the serum and peripheral blood mononuclear cells of all 25 zoster patients documents that viremia is a common manifestation of herpes zoster. Sorivudine cream appears to be a safe and well-tolerated adjuvant therapy; however, further phase 2 studies are needed to determine its clinical efficacy for the treatment of herpes zoster. Trials registration. ClinicalTrials.gov identifier: NCT00652184.
Satyaprakash
Anita K
AK
Center for Clinical Studies, University of Texas Health Science Center, Houston, Texas, USA.
Tremaine
Anne Marie
AM
Stelter
Arwen A
AA
Creed
Rosella
R
Ravanfar
Parisa
P
Mendoza
Natalia
N
Mehta
Satish K
SK
Rady
Peter L
PL
Pierson
Duane L
DL
Tyring
Stephen K
SK
D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D004311:Double-Blind Method; D005260:Female; D006562:Herpes Zoster / Q000188:drug therapy* / Q000235:genetics; D014645:Herpesvirus 3, Human / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010919:Placebos; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014766:Viremia / Q000188:drug therapy*
D000998:Antiviral Agents; D004279:DNA, Viral; D010919:Placebos; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir