Acyclovir Efficiently Inhibits Oropharyngeal Excretion of Epstein-Barr Virus in Patients with Acute Infectious Mononucleosis

Abstract

SUMMARYShedding of Epstein-Barr virus (EBV) into saliva was studied in 31 patients with verified acute infectious mononucleosis. The patients had been randomized for intravenous treatment with acyclovir (ACV) at 10 mg/kg body weight at 8 h intervals for 7 days, or placebo, in a double-blind trial. EBV in centrifuged throat washings was detected by transformation of umbilical cord lymphocytes and by immunofluorescence staining for EBV-associated nuclear antigen in fixed cell smears. Saliva samples were obtained before and during treatment, and after 4 weeks and 6 months, respectively. ACV effectively but transiently interrupted EBV production (P < 0.001), but virus shedding resumed at the initial level within 3 weeks of cessation of the treatment. Initially, 93-5 ~ of the patients had detectable EBV in the saliva compared with 83 ~ in the 4th week and 58 ~o after 6 months. et al., 1977) which efficiently inhibits not only herpes simplex virus (Schaeffer et al., 1978) but also varicella-zoster virus (Biron & Elion, 1980) and Epstein-Barr virus (EBV) (Colby et al., 1979;Lin et al., 1984) replication in vitro. Both human herpes simplex virus and varicella-zoster virus direct the initial phosphorylation of ACV by the virus-specific thymidine kinase, and after two additional phosphorylations mediated by the cell, the biologically active triphosphorylated form is produced (Elion et al., 1977). This form of ACV inhibits viral DNA polymerase competitively , and also terminates the viral DNA chain because the drug is incorporated in the viral DNA molecule in place of deoxyguanosine monophosphate (Furman et al., 1979). Since an EBV-coded thymidine kinase has recently been identified At pharmacological doses acyclovir (ACV) is a non-toxic antiviral nucleoside analogue (Elion

Acyclovir Reduces the Duration of Fever in Patients with Infectious Mononucleosis-like Illness

“…Acyclovir antiviral activity against EBV was also reported in vitro (Long et al 2003). Some studies have shown that acyclovir combined with prednisolone inhibits replication of oropharyngeal EBV without affecting the duration of IM clinical symptoms (Ernberg and Andersson 1986;Tynell et al 1996). However, no studies have yet reported clinical data indicating that acyclovir is effective in the treatment of EBV-IM and IM-like illness in vivo.…”

The Epstein-Barr virus and its association with human cancers

“…Second, treatment of latently infected individuals with long term acyclovir eliminates virus excretion but does not aVect the level of latent infection in B cells. 11 When treatment is stopped, the virus can be detected in the oropharyngeal secretions at pretreatment levels. 12 Third, studies of EBV strains in donor-recipient pairs before and after bone marrow transplantation have shown that the recipient's strain disappears from the oropharynx and is replaced by the donor's strain.…”

Eradication of Epstein-Barr virus by allogeneic bone marrow transplantation: implications for sites of viral latency.

“…Growing cells were harvested from their wells and the resulting LCLs were expanded. EBV was also recovered from mouthwashes of patient 1, her husband, and patient'2's donor by using the cord blood cell transformation assay (22). EiIV Serology.…”