Oral Acyclovir for Prevention of Herpes Simplex Virus Reactivation After Marrow Transplantation

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Abstract
Oral acyclovir was found to be safe and effective for the prevention of herpes simplex virus reactivation after marrow transplantation in a double-blind, placebo-controlled trial. Acyclovir or placebo was administered to 49 patients for 5 wk beginning 1 wk before transplantation: 5 of 24 patients receiving acyclovir developed herpes simplex virus infection during prophylaxis, compared to 17 of 25 patients receiving placebo (P < 0.01). The median time to 1st virus reactivation was significantly longer among patients receiving acyclovir (78 days vs. 9 days after transplant, P = 0.006). The effect was even more pronounced when the analysis was adjusted for drug compliance: among patients taking a minimum of 40% of their prescribed drug, acyclovir was 96% virologically effective and 100% clinically effective during the period of administration. Acyclovir use was also associated with significantly more rapid marrow engraftment in patients receiving methotrexate [an antineoplastic agent]. No virus resistant to acyclovir was isolated. Oral acyclovir provides effective prophylaxis against reactivation of herpes simplex virus among severely immunosuppressed patients able to take orally administered drugs.