Acyclovir prophylaxis against herpes virus infections in severely immunocompromised patients: randomised double blind trial

• Published in: BMJ 1983-08, Vol.287 (6389), p.384-385/388
• Main Authors: Hann, I M, Prentice, H G, Blacklock, H A, Ross, M G, Brigden, D, Rosling, A E, Burke, C, Crawford, D H, Brumfitt, W, Hoffbrand, A V
• Format: Article
• Language: English
• Subjects: Acyclovir - therapeutic use; Adult; Agranulocytosis; Agranulocytosis - complications; Bone Marrow Transplantation; Clinical Research; Clinical Trials as Topic; Cytomegalovirus infections; Double-Blind Method; Female; Fever; Herpesviridae Infections - complications; Herpesviridae Infections - prevention & control; Humans; Immunosuppression; Infections; Leukemia - therapy; Male; Placebos; Saliva; Simplexvirus; Varicella zoster encephalitis; Viruses
• ISSN: 0007-1447; 0267-0623; 0959-8138; 1468-5833
• DOI: 10.1136/bmj.287.6389.384

Twenty patients undergoing allogeneic bone marrow transplantation and 39 patients receiving remission induction chemotherapy for acute leukaemia were entered into a double blind, placebo controlled stratified trial of acyclovir prophylaxis against herpes group virus infections. Within the transplant group intravenous acyclovir 5 mg/kg twice daily given throughout the period of granulocytopenia completely prevented oropharyngeal herpes simplex virus infection compared with a 50% incidence in the placebo arm (p = 0.033). The acyclovir group also had fewer days of fever during the trial and a shorter duration of leukopenia, possibly because of the prevention of herpes simplex virus infections. There was a high incidence of herpes infections after the trial in patients who received either acyclovir or placebo. In the non-transplant group there was also a significant reduction of herpes simplex virus infection in the oropharynx and oesophagus (two out of 19 patients as compared with 10 out of 20; p = 0.018). Herpes simplex virus was isolated in the acyclovir arm within a day after starting the trial in one patient, and the other failure was due to a virus with reduced sensitivity to acyclovir in a patient who had had several previous courses of the drug. The incidence of herpes infections after stopping treatment was low. The influence of acyclovir on excretion of Epstein-Barr virus in saliva in either group was inconclusive. One patient (transplant group) developed a cytomegalovirus infection while receiving acyclovir. Acyclovir provides effective prophylaxis against oropharyngeal and oesophageal herpes simplex virus infection in severely immunocompromised seropositive (greater than or equal to 1/8) patients. In patients given bone marrow transplants this may have the additional benefit of reducing the time to recovery of an adequate blood count and the number of days of fever.