Intravenous Acyclovir to Treat Mucocutaneous Herpes Simplex Virus Infection After Marrow Transplantation

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Abstract
Acyclovir, a new antiviral agent, was compared to a placebo in a randomized double-blind trial of treatment for culture-proven herpes simplex virus infection after marrow transplantation. Patients received either i.v. acyclovir at 750 mg/m2 body surface area/day or a placebo for 7 days. Of 17 patients, 13 given acyclovir had a beneficial response as compared with 2 of 17 given the placebo (P < 0.01). The duration of positive cultures was shorter among acyclovir recipients (3 vs. 17 days, P < 0.00005). Also shorter were the median days to resolution of pain (10 vs. 16 days, P = 0.03), to crusting of lesions (7 vs. 14 days, P = 0.01) and to total healing (14 vs. 28 days, P = 0.03). No acyclovir toxicity was observed. Recurrent infection was common. Acyclovir provided significant antiviral and clinical efficacy without toxicity in highly immunosuppressed patients but had no effect on virus latency.