Prevention of Herpesvirus Infections in Renal Allograft Recipients by Low-Dose Oral Acyclovir

Abstract

Forty patients with serum antibody against herpes simplex virus (HSV) were enrolled in a randomized, placebo-controlled, double-blind investigation of acyclovir given orally in a low dosage as prophylaxis against recurrent HSV infection after renal transplantation. During 30 postoperative days of medication, 14 of 21 placebo-treated and one of 19 acyclovir-treated patient(s) developed reactivation of HSV infection. Eleven of the former, but not the latter, had herpetic lesions. The protection against active infection with HSV during the period of prophylaxis with acyclovir is statistically highly significant. From 30 to 90 days after transplantation when no antiviral medicine was given, 60% (3/5) of the remaining placebo recipients and 44% (7/16) of the acyclovir patients developed active HSV infections. Herpetic lesions occurred in two of three and two of seven of infected people in the respective groups. No adverse effects of the drug were observed. The results show that HSV infections in immunosuppressed renal allograft recipients can be safely prevented, deferred, and ameliorated by an initial period of prophylaxis with a low dose of oral acyclovir.

Herpes Simplex Virus in Solid Organ Transplantation

“…Compared with immunocompetent persons, solid organ transplant (SOT) recipients shed virus more frequently, have more frequent and severe clinical manifestations of HSV , and may be slower to respond to therapy. Most symptomatic HSV disease in adult transplant recipients results from reactivation of previously acquired virus, particularly early after transplantation and in the setting of antirejection therapy . Primary infection from the allograft is rare but described in liver, kidney and other organ transplant types .…”

“…The most common clinical presentation of HSV is orolabial, genital or perianal disease . Lesions can be classic vesicular and/or ulcerative and may extend locally.…”

Oral and perioral herpes simplex virus type 1 (HSV‐1) infection: review of its management*

“…Oral ACV may also provide effective and safe prophylaxis for post‐renal transplant HSV‐1 infection (Pettersson et al , 1985; Seale et al , 1985).…”

Fatal case of cutaneous‐sparing orolaryngeal zoster in a renal transplant recipient

“…Before the era of routine antiviral prophylaxis, VZV and HSV reactivated in renal transplant recipients as early as the first month post transplant . In the current era of antiviral prophylaxis, the incidence of HZ was estimated at 6.4%‐7.4% among KT recipients, with onset being rare while the patient is on antiviral prophylaxis, but occurring at any point after discontinuation .…”