Acyclovir Prophylaxis of Herpes-Simplex-Virus Infections

TLDR

A double‑blind, placebo‑controlled trial enrolled 20 HSV‑seropositive bone‑marrow transplant recipients who received acyclovir or placebo for 18 days starting three days before transplantation. Acyclovir prevented HSV lesions in all 10 treated patients versus 7 of 10 placebo patients (P ≈ 0.003) and caused no drug toxicity, and after stopping therapy 5 patients had mild HSV infections and 2 shed virus without lesions, showing potent inhibition but not eradication of latent infection. Published in the New England Journal of Medicine, 1981, 305:63–7.

Abstract

We conducted a double-blind, placebo-controlled study of acyclovir prophylaxis against infection with herpes simplex virus (HSV) in 20 seropositive recipients of bone-marrow transplants. Acyclovir or placebo was administered for 18 days, starting three days before transplantation. Culture-positive HSV lesions developed during the study in seven of the 10 patients who received placebo. In contrast, no such lesions appeared in the 10 patients who received acyclovir (P≃0.003). None of the patients had evidence of drug toxicity. Five of the patients treated with acyclovir had mild culture-positive HSV infections after cessation of the drug, and two additional patients shed virus without having lesions. Acyclovir appears to be a potent inhibitor of HSV replication. Although acyclovir does not appear to eradicate latent infection, it can provide effective prophylaxis against reactivated infections. (N Engl J Med. 1981; 305:63–7.)