YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==HERPES== 5 AUTHOR Dudley MN TITLE Management of herpesvirus infections in the healthy host. SOURCE Pharmacotherapy; VOL 15, ISS 5 Pt 2, 1995, P43S-48S (REF: 31) ABSTRACT Human herpesvirus infections continue to be a concern in immunocompetent as well as immunocompromised hosts. They are often life threatening in the immunocompromised patient. In the healthy immunocompetent person the infections tend to be self-limited, although they can directly or indirectly cause periods of severe discomfort and disability, and their treatment can affect productivity, as shown by cost-outcome models. Treatment of primary or secondary episodes in the immunocompetent host is therefore directed toward more rapid resolution of initial and recurrent episodes, thereby limiting the impact of the infections. 26 AUTHOR Baker DA TITLE Herpes simplex virus infections. SOURCE Curr Opin Obstet Gynecol; VOL 4, ISS 5, 1992, P676-81 (REF: 21) ABSTRACT This review discusses current reports on herpes simplex virus infections as they relate to the use of laboratory testing, infections in the neonate, herpes simplex virus association with human immunodeficiency virus infection, and updating the current therapy and management of genital herpes. Findings over the past year are important in the clinical management of patients with genital herpes. All health care workers who manage patients with genital herpes need to know the limitations of serologic testing. Current information suggests that serologic commercial testing that is most commonly available cannot discriminate between infections caused by herpes simplex virus type 1 and type 2. Laboratory methods still rely on culturing herpes simplex virus in living cells in vitro. However, the availability of monoclonal antibodies allows for rapid assays for the confirmation of cultured herpes simplex virus. In addition, assays have been developed and tested, suggesting that perhaps antigen-detection systems may be available that could replace culturing the virus in living cells. New information on neonatal herpes points out the predictors of morbidity and mortality in newborns who contract herpes within the first few weeks of life. Information concerning asymptomatic shedding in labor will provide the clinician with a better understanding of this disease entity in the pregnant woman. Several studies have confirmed that herpes simplex virus infection is a risk factor for developing human immunodeficiency virus infection. A new study clearly shows that treatment using daily acyclovir therapy over a prolonged period of time can control and may modify herpesvirus infection. 33 AUTHOR Arbesfeld DM AUTHOR Thomas I TITLE Cutaneous herpes simplex virus infections [see comments] SOURCE Am Fam Physician; VOL 43, ISS 5, 1991, P1655-64 (REF: 21) ABSTRACT Affecting millions of Americans each year, herpes simplex virus infections are among the most common human viral infections. Many clinical forms exist, depending on the site of infection and the patient's age and immune status. Clinical evaluation and laboratory studies help establish the diagnosis. Acyclovir is the drug most often used to treat herpes simplex virus infections, although newer agents, such as phosphonoformate trisodium, may be required for acyclovir-resistant infections. 61 AUTHOR True BL AUTHOR Carter BL TITLE Update on acyclovir: oral therapy for herpesvirus infections. SOURCE Clin Pharm; VOL 3, ISS 6, 1984, P607-13 (REF: 45) ABSTRACT The results of the major human clinical trials on oral acyclovir are reviewed, and the pharmacokinetics, adverse effects, and role of oral acyclovir in the management of herpes simplex virus (HSV) infections are discussed. Clinical studies have demonstrated the effectiveness of oral acyclovir in causing significant reductions in the duration of viral shedding, development of new lesions, and time to crusting and healing in several clinical situations. The drug appears to achieve the most dramatic results in the treatment of initial primary genital herpes infections. Oral acyclovir also has a potential role in suppressing reactivations of HSV infections in immunocompromised patients or patients experiencing greater than 10-12 recurrences of genital herpes per year. Most trials have used 200-mg capsules administered five times daily for 5-10 days for treating acute infections. Reduced doses have been successful for suppressive therapy. Acyclovir does not alter the frequency of recurrence once treatment has been discontinued. The absolute bioavailability of oral acyclovir is approximately 20%, and plasma concentrations are about one tenth of those achieved after a typical i.v. infusion. The relationship between plasma concentration and clinical response has not been established. The half-life is 3-4 hours, and the predominant route of elimination is via renal excretion and tubular secretion. Clinical studies have consistently reported minimal adverse effects with oral acyclovir. Conservative use is justified by the potential development of resistant viral strains. The extent and clinical importance of resistant viral selection remain to be determined. Oral acyclovir represents an advance in the development of a nontoxic antiviral agent suitable for both hospitalized and ambulatory patients that should be recommended for formulary inclusion. 66 AUTHOR Bryson YJ TITLE Current status and prospects for oral acyclovir treatment of first episode and recurrent genital herpes simplex virus. SOURCE J Antimicrob Chemother; VOL 12 Suppl B, 1983, P61-5 (REF: 9) ABSTRACT Herpes simplex genitalis is an increasingly common primary or recurrent HSV infection. Acyclovir (ACV) has been found to diminish virus shedding and clinical symptoms in patients with first episode genital HSV when given topically or intravenously. As most patients with first episode disease do not require hospitalization and recurrent disease is usually less severe than the primary infection, out-patient treatment forms the basis of practical management. Acyclovir is absorbed orally with plasma concentrations which exceed in vitro inhibitory concentrations for HSV1 and HSV2. In double blind studies in over 100 recipients with first episode HSV, oral ACV treatment (200 mg, 5 times daily) significantly reduced virus shedding, new lesion formation, duration of genital lesions and clinical symptoms in both men and women when compared with placebo recipients. No toxicity was observed. Recurrence rates following the first episode were similar in placebo and ACV groups. A multi-centre double blind trial of oral ACV treatment of recurrent HSV infection in 250 patients showed that the duration of virus shedding and lesions was significantly shorter in ACV versus placebo recipients. These effects were more pronounced when therapy was self-initiated by patients early on during a recurrence or during the prodromal period. Oral acyclovir has significant clinical and virological effects in both primary and recurrent genital HSV infections. 13 AUTHOR Lawee D AUTHOR Rosenthal D AUTHOR Aoki FY AUTHOR Portnoy J TITLE Efficacy and safety of foscarnet for recurrent orolabial herpes: multicenter randomized double blind study SOURCE Can. Med. Assoc. J.; VOL 138 ISS Feb 15 1988, P329-333, (REF 13) ABSTRACT IPA COPYRIGHT: ASHP A report of foscarnet sodium (trisodium phosphonoformate hexahydrate; I) 3% cream therapy for recurrent orolabial herpes in 143 patients, aged 18-70 yr, is presented; efficacy was evaluated in 74 patients receiving I and 69 patients receiving placebo. There was no significant difference in time to healing or duration of virus shedding between the 2 groups. However, in the subgroup of patients who started treatment before vesicles appeared, the duration of virus shedding was shorter in the I group than in the placebo group, and the proportion of lesions that evolved to the vesicular stage was smaller. It was concluded that the beneficial effect of I was limited to a subgroup of patients who started treatment in the prevesicular stage. 34 AUTHOR Hirsch MS AUTHOR Schooley RT TITLE Treatment of herpesvirus infections SOURCE N. Engl. J. Med.; VOL 309 ISS Oct 20; 27 1983, P963-970; 1034-1039, (REF 152) ABSTRACT IPA COPYRIGHT: ASHP A review of the treatment of herpesvirus infections with vidarabine, acyclovir and other antiviral agents, such as interferon, trisodium phosphonoformate (foscarnet sodium), bromovinyldeoxyuridine and fluoroiodoaracytosine, is presented. 37 AUTHOR Marks RG TITLE New drugs preview. Part 3. Antivirals. Herpes: help is on the way SOURCE Drug Top.; VOL 125 ISS Jul 17 1981, P34-37, (REF ) ABSTRACT IPA COPYRIGHT: ASHP Antiviral drugs, such as acyclovir, arildone and its analog (Win-41258-3), phosphonoformate trisodium (foscarnet sodium) and phosphonoacetic acid, were previewed for their use against herpes infections. It was concluded that, although the new drugs are promising, the best is yet to come from interferon research in cancer.