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Pathogen:
Varicella-zoster virus (herpes zoster, VZV).
Sites of Infection:
Symptoms:
Diagnosis:
Treatment Results:
Results from a phase III study (ACTG 169) of sorivudine (BV ara-U) (40 mg once daily for10 days) vs acyclovir (800 mg five times daily for10 days) in localized zoster demonstrated superiority of BV ara-U (Gnann et al.). All patients were enrolled within 72 hours of rash onset and evaluated daily until lesions were completely crusted. The median time to cessation of new vesicle formation was shorter in the sorivudine group (3 days) than in the acyclovir group (4 days). Median time to 100% crusting was also shorter in the sorivudine group (7 days) than in the acyclovir group (8 days). Time to resolution of zoster-associated pain was not different between the two groups.
Similar findings from a European study of the safety and efficacy of sorivudine were presented by Dehertogh et al. Sorivudine (40 mg once daily) was compared with the standard acyclovir dose of 800 mg 5 times daily among 137 HIV-positive individuals. This study was halted when the second interim analysis revealed a statistical difference between the two therapies in favor of BV ara-U. Patients were followed for 6 months. Sorivudine reduced the mean number of days to cessation of new lesion formation and time to 100% crusting by one-third compared to acyclovir. Time to cessation of acute pain and time to resolution of post-therapeutic neuralgia was not different between the two therapies.
Safrin et al. treated five AIDS patients with acyclovir-resistant varicella-zoster virus (VZV) with foscarnet (40 mg/kg IV three times daily for more than 10 days). 4/5 patients had complete or nearly complete healing of lesions. 2/4 had a relapse 7-14 days after completing foscarnet therapy; isolates from both patients showed susceptibility to acyclovir in vitro. One relapse patient responded to intravenous acyclovir; one patient did not respond to oral acyclovir (4,000 mg daily for12 days).
Famciclovir is being investigated in a clinical trial for the treatment of first time herpes zoster infection in HIV-positive people.
A phase I trial (ACTG 253) to evaluate the pharmacokinetics, safety, and tolerance of valacyclovir in HIV-positive children (ages 12 and under) with herpes zoster or herpes simplex infection in currently underway. A second trial in HIV-positive children (ACTG 265) is examining the safety and immunogenicity of live, attenuated varicella vaccine (Varivax).
REFERENCES:
Gnann J et al. Sorivudine (BV-ara-U) versus acyclovir for herpes zoster in HIV-infected patients. Abstract #12, 3rd Conf on Human Retro and Opport Infect, Washington DC, 1996.
Jacobson MA et al. Acyclovir-resistant varicella zoster virus infection after chronic oral acyclovir therapy in patients with the acquired immune deficiency syndrome (AIDS). Am Int Med 112(3): 187-91, 1990.
Safrin S et al. Foscarnet therapy in five patients with AIDS and acyclovir-resistant varicella-zoster virus infection. Ann Int Med 115(l): 19-21, 1991.
Return to the Herpes Zoster Menu
VZV, the chicken-pox virus, resides in the nerve roots adjacent to the spine; herpes zoster (shingles) represents an acute reactivation of VZV. These lesions typically affect the face and trunk.
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Return to the Herpes Zoster Menu
Return to the Herpes Zoster Menu
Return to the Herpes Zoster Menu
Dehertogh et al. The safety and efficacy of sorivudine (BV-ara-U) for the treatment of zoster in HIV-infected adults. Abstract #A/7, 34th ICAAC, Orlando, 1994.
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