Valacyclovir prophylaxis for the prevention of Herpes simplex virus reactivation in recipients… – Abstract

Background Herpes simplex virus and varicella zoster virus reactivation can occur in up to 32% and 40% of patients, respectively in the first year post-transplant without prophylaxis. Intravenous acyclovir is effective in preventing HSV reactivations, but expensive. All patients received foscarnet; 8 subsequently received cidofovir. HIV-1 viral load was the outcome. Valacyclovir group: From October 1997 to April 1999 108 adult patients received valacyclovir 500 mg twice daily from day -3 of APCT until neutropenia recovery or day +30. Valacyclovir was switched to intravenous acyclovir in cases of oral intolerance (17 patients) or suspected HSV reactivation (five patients). Intravenous acyclovir group: From January 1996 to October 1997 43 patients received 5 mg/kg twice-daily intravenous acyclovir from day -3 until recovery from neutropenia.

No prophylaxis group: 38 patients from January 1996 to October 1997 did not receive HSV prophylaxis. HSV reactivations were seen in 2.7%, 2% and 45% of patients in the valacyclovir, intravenous acyclovir, and no prophylaxis groups, respectively. Prophylactic strategies that use ganciclovir include the early initiation of preemptive ganciclovir therapy on the basis of a diagnosis of CMV antigenemia or PCR positive for CMV DNA, and universal ganciclovir prophylaxis initiated at the time of marrow engraftment and continued until day 100 after transplantation [4–7]. Oral valacyclovir was as effective as intravenous acyclovir for the prophylaxis of HSV reactivation in APCT patients.