Efficacy of Valacyclovir vs Acyclovir for the Prevention of Recurrent Herpes Simplex Virus Eye Disease: A Pilot Study

University of Milan, Milano, Lombardy, Italy
American Journal of Ophthalmology (Impact Factor: 3.87). 11/2007; 144(4):547-51. DOI: 10.1016/j.ajo.2007.06.001
Source: PubMed


To compare the efficacy of one-year treatment with valacyclovir vs acyclovir in preventing recurrence of the herpes simplex virus (HSV) eye disease.
Prospective, randomized, clinical trial pilot study.
Fifty-two immunocompetent patients with a history of recurrent ocular HSV disease were treated at the Ocular Immunology Service, San Raffaele Hospital, Milan, Italy. Twenty-six patients were randomized to the valacyclovir group (one 500 mg tablet daily), and 26 patients were randomized to the acyclovir group (one 400 mg tablet twice daily). The recurrence rate of ocular HSV disease during 12 months of treatment and drug-related side effects were monitored.
Recurrence of any type of ocular HSV disease during the 12-month treatment period was 23.1% in the valacyclovir group, compared with 23.1% in the acyclovir group. No difference between the two groups was observed regarding the nature, frequency, or severity of adverse events. The most frequent adverse events were nausea and headache.
One-year suppression therapy with oral valacyclovir (500 mg tablet daily) was shown to be as effective and as well tolerated as acyclovir (400 mg tablet twice daily) in reducing the rate of recurrent ocular HSV disease.

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    • "Moreover, till date there are only a handful of antiviral agents are available , which are costly, yielded drug-resistant mutants and have toxicity. The antiherpes drug acyclovir and the related analogs frequently yielded drug-resistant viruses (Kleymann 2003; Miserocchi et al. 2007) and adverse drug reactions in pregnancy (Narayana 2008), neonates and children (Sawyer et al. 1988). Therefore, there is an unmet need for cheap, readily available natural agents to prevent microbial infections, with minimum side effects. "
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    ABSTRACT: To evaluate the in vitro antimicrobial activity of aqueous and methanol extracts of Odina wodier bark (OWB), a folk medicine, against representative bacteria, fungi and herpes simplex virus (HSV) associated with skin infections. The OWB extract(s) was found to inhibit the isolates of Staphylococcus aureus, Bacillus subtilis, Pseudomonas aeruginosa, Klebsiella pneumonia, Escherichia coli at an MIC of 256-5000 μg ml(-1) and Candida albicans at and above 4000 μg ml(-1) by agar and broth dilution assays. The growth curve of S. aureus revealed the highest activity within 2-6h of methanol extract (ME) exposure. Interestingly the MTT and plaque reduction assay showed that the extracts can inhibit HSV-1 and HSV-2 at EC50 of 22.4 and 28.8 μg ml(-1) , with Selectivity index of 11.7-15. While the time kinetic and binding assays demonstrated that the ME at 50 μg ml(-1) prevents viral attachment into Vero cells. Phytochemical and HPLC analysis of ME revealed the presence of flavonoids, phytosterols, saponins, and tannins including the pseudotannin chlorogenic acid. The traditional use of OWB for the management of skin infections has scientific basis. This study demonstrated the antimicrobial potential of OWB on selected isolates of bacteria, fungi and HSV, associated with skin infections. This article is protected by copyright. All rights reserved.
    Journal of Applied Microbiology 08/2013; 115(6). DOI:10.1111/jam.12330 · 2.48 Impact Factor
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    • "Several antiviral drugs have shown efficacy in the treatment of ocular HSV-1 keratitis, including acyclovir, valacyclovir, cidofovir, trifluorothymidine, and ganciclovir [23–25]. First line therapy for HSV-1 is acyclovir or valacyclovir [1, 26, 27]. Epithelial infection is usually treated with 3% acyclovir ointment for two weeks, while stromal necrotizing or non-necrotizing infections are treated with acyclovir in combination with a corticosteroid [28, 29]. "
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    ABSTRACT: Ocular gene therapy is rapidly becoming a reality. By November 2012, approximately 28 clinical trials were approved to assess novel gene therapy agents. Viral infections such as herpetic keratitis caused by herpes simplex virus 1 (HSV-1) can cause serious complications that may lead to blindness. Recurrence of the disease is likely and cornea transplantation, therefore, might not be the ideal therapeutic solution. This paper will focus on the current situation of ocular gene therapy research against herpetic keratitis, including the use of viral and nonviral vectors, routes of delivery of therapeutic genes, new techniques, and key research strategies. Whereas the correction of inherited diseases was the initial goal of the field of gene therapy, here we discuss transgene expression, gene replacement, silencing, or clipping. Gene therapy of herpetic keratitis previously reported in the literature is screened emphasizing candidate gene therapy targets. Commonly adopted strategies are discussed to assess the relative advantages of the protective therapy using antiviral drugs and the common gene therapy against long-term HSV-1 ocular infections signs, inflammation and neovascularization. Successful gene therapy can provide innovative physiological and pharmaceutical solutions against herpetic keratitis.
    Journal of Ophthalmology 12/2012; 2012(6):594869. DOI:10.1155/2012/594869 · 1.43 Impact Factor
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    • "The widely used anti-herpes virus drug acyclovir is a nucleoside analogue, specifically targets the thymidine kinase of HSV [39]. However, its extensive and long term use yielded drug-resistant strains [9,11], due to mutations in viral thymidine kinase and/or DNA polymerase, that alter substrate sensitivity [40], and thus, become chromosome mutagen. Moreover, efficacy of therapeutic vaccines against primary and recurrent HSV infection has failed [15] and thus, search for natural alternative is the top priority to control and prevent HSV infections and its transmission. "
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    ABSTRACT: Viral infections, particularly the infections caused by herpes simplex virus (HSV), represent one of the most serious public health concerns globally because of their devastating impact. The aim of this study was to evaluate the antiviral potential of methanolic crude extract of an ethnomedicine Mallotus peltatus, its active fraction and pure compound, against HSV-1 F and HSV-2 G. The cytotoxicity (CC(50), the concentration of 50% cellular toxicity), antiviral effective concentration (EC(50), the concentration required to achieve 50% protection against virus-induced cytopathic effect), plaque reduction and the selectivity index (SI, the ratio of CC(50) and EC(50)) was determined. Results showed that the crude methanolic extract of M. peltatus possessed weak anti-HSV activity. In contrast, the active fraction A and isolated ursolic acid from fraction A exhibited potent antiherpesvirus activity against both HSV-1 (EC(50)= 7.8 and 5.5 μg/ml; SI = 22.3 and 20) and HSV-2 (EC(50)= 8.2 and 5.8 μg/ml, and SI = 21.2 and 18.97). The fraction A and isolated ursolic acid (10 μg/ml) inhibited plaque formation of HSV-1 and HSV-2 at more than 80% levels, with a dose dependent antiviral activity, compared to acyclovir. The time response study revealed that the anti-HSV activity of fraction A and isolated ursolic acid is highest at 2-5 h post-infection. Moreover, the time kinetics study by indirect immunofluorescence assay showed a characteristic pattern of small foci of single fluorescent cells in fraction A- treated virus infected cells at 2 h and 4 h post-infection, suggesting drug inhibited viral dissemination. Further, the PCR study with infected cell cultures treated with fraction A and isolated ursolic acid at various time intervals, failed to show amplification at 48-72 h, like acyclovir treated HSV-infected cells. Moreover, fraction A or isolated ursolic acid showed no interaction in combination with acyclovir. This study revealed that bioactive fraction A and isolated ursolic acid of M. peltatus has good anti-HSV activity, probably by inhibiting the early stage of multiplication (post-infection of 0-5 h), with SI value of 20, suggesting its potential use as anti-HSV agents.
    Virology Journal 05/2012; 9(1):98. DOI:10.1186/1743-422X-9-98 · 2.18 Impact Factor
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