Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Valacyclovir”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources
PubMed1998

The Albion Street Centre database, Sydney, Australia.

The Albion Street Centre was established in 1985 as an HIV testing and early management center. More than 22,000 people have been screened for HIV and other blood-borne infections at the Centre, and approximately 3,600 people with HIV/AIDS have been managed there. Approximately 1,600 patients with various stages of HIV disease are currently managed at the Centre by a staff of 60 health care professionals and about 1,000 volunteers. The Albion Street Centre's computer database began recording selected demographic, epidemiologic, clinical, and laboratory characteristics when the first patient presented in 1985. Since then, the complexity and utilization of the database has increased in parallel with improvement in the understanding of the natural history and pathogenesis of HIV infection. Over 100 peer-reviewed publications and presentations have been produced from the database and 45 clinical trials have used the database to identify potential subjects. All data are de-identified and are protected by multiple password codes. Approximately 700 variables are collected from each HIV-positive patient at the initial visit to the Centre and up to 200 variables are added at each subsequent routine clinic visit. The variables collected include the following: standard epidemiologic characteristics; transmission and behavioral parameters, clinical signs and symptoms; laboratory test results; treatments; nutritional history; body composition parameters; psychological assessment results; and management history, including neuropsychological testing. The overall number and characteristics of patients recorded in the database are reported monthly, and are used to plan services, for prevention and educational programs, and as an indicator of the effectiveness of campaigns to encourage HIV-positive people to attend clinics for early management. When these patients have been identified they are invited to participate in the study. Individual patient records are identified and accessed if they meet certain criteria for flagging. For example, patients who have lost more than 5% of their maximal weight are flagged and referred to the dietician for assessment. Further uses for the database are to identify cohorts of patients who are seroconverters and to follow their natural history-the Centre has over 250 patients for whom a documented HIV-positive test has been obtained within 12 months of a documented HIV-negative test; to investigate clinical observations that have been associated with particular drug therapy, e.g., investigation of the reported association between the use of valacyclovir and the thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS)-like complex showed patients with terminal-stage AIDS demonstrated this syndrome independently of their therapy and probably as a consequence of multiorgan failure; and to document the relationship between nutritional intervention and survival, for which use of the database enabled an historical cohort that matched the cases under investigation to be selected. In conclusion, the database is a dynamic and integral part of the assessment, management, and research program of the Albion Street Centre, where it is used by all professional staff.

Adolescent↗
PubMed2002

Human organic anion transporters and human organic cation transporters mediate renal antiviral transport.

Renal excretion is an important elimination pathway for antiviral agents, such as acyclovir (ACV), ganciclovir (GCV), and zidovudine (AZT). The purpose of this study was to elucidate the molecular mechanisms of renal ACV, GCV, and AZT transport using cells stably expressing human organic anion transporter 1 (hOAT1), hOAT2, hOAT3, and hOAT4, and human organic cation transporter 1 (hOCT1) and hOCT2. Time- and concentration-dependent uptake of ACV and GCV was observed in hOAT1- and hOCT1-expressing cells. In contrast, uptake of valacyclovir, L-valyl ester of ACV, was observed only in hOAT3-expressing cells. On the other hand, AZT uptake was observed in hOAT1-, hOAT2-, hOAT3-, and hOAT4-expressing cells. The Km values of ACV uptake by hOAT1 and hOCT1 were 342.3 and 151.2 microM, respectively, whereas those of GCV uptake by hOAT1 and hOCT1 were 895.5 and 516.2 microM, respectively. On the other hand, the Km values of AZT uptake by hOAT1, hOAT2, hOAT3, and hOAT4 were 45.9, 26.8, 145.1, and 151.8 microM, respectively. In addition, probenecid weakly inhibited the hOAT1-mediated ACV uptake. In conclusion, these results suggest that hOAT1 and hOCT1 mediate renal ACV and GCV transport, whereas hOAT1, hOAT2, hOAT3, and hOAT4 mediate renal AZT transport. In addition, L-valyl ester appears to be important in differential substrate recognition between hOAT1 and hOAT3. hOAT1 may not be the molecule responsible for the drug interaction between ACV and probenecid.

Acyclovir↗
PubMed1996

Varicella-zoster virus.

Varicella-zoster virus (VZV) is a ubiquitous human alphaherpesvirus that causes varicella (chicken pox) and herpes zoster (shingles). Varicella is a common childhood illness, characterized by fever, viremia, and scattered vesicular lesions of the skin. As is characteristic of the alphaherpesviruses, VZV establishes latency in cells of the dorsal root ganglia. Herpes zoster, caused by VZV reactivation, is a localized, painful, vesicular rash involving one or adjacent dermatomes. The incidence of herpes zoster increases with age or immunosuppression. The VZV virion consists of a nucleocapsid surrounding a core that contains the linear, double-stranded DNA genome; a protein tegument separates the capsid from the lipid envelope, which incorporates the major viral glycoproteins. VZV is found in a worldwide geographic distribution but is more prevalent in temperate climates. Primary VZV infection elicits immunoglobulin G (IgG), IgM, and IgA antibodies, which bind to many classes of viral proteins. Virus-specific cellular immunity is critical for controlling viral replication in healthy and immunocompromised patients with primary or recurrent VZV infections. Rapid laboratory confirmation of the diagnosis of varicella or herpes zoster, which can be accomplished by detecting viral proteins or DNA, is important to determine the need for antiviral therapy. Acyclovir is licensed for treatment of varicella and herpes zoster, and acyclovir, valacyclovir, and famciclovir are approved for herpes zoster. Passive antibody prophylaxis with varicella-zoster immune globulin is indicated for susceptible high-risk patients exposed to varicella. A live attenuated varicella vaccine (Oka/Merck strain) is now recommended for routine childhood immunization.

Acyclovir↗
PubMed1998

Treatment of acyclovir-resistant herpetic ulceration with topical foscarnet and antiviral sensitivity analysis.

BACKGROUND: Herpes simplex virus (HSV) can produce persistent mucocutaneous disease in patients with the acquired immunodeficiency syndrome (AIDS). In this case report, we evaluate the efficacy, safety and viral resistance after topical foscarnet in severe genital ulceration due to acyclovir-resistant HSV-2. CASE REPORT: A 45-year-old African woman was known for an HIV infection with severe immunosuppression (CD4 <100/mm3). She had received a long-term prophylaxis with acyclovir (400 mg b.i.d.) for a recurrent genital herpes. Few weeks after stopping this prophylaxis, she developed large genital ulcerations progressing despite valacyclovir treatment (1,000 mg t.i.d.). Cultures were positive for HSV-2, resistance to acyclovir was shown by the plaque reduction assay and topical foscarnet was tried. Treatment consisted of a 20-min application of topical foscarnet 2.4% twice a day. Dramatic improvement was observed with rapid antalgia, and cicatrization of the genital ulcerations was observed after 50 days. HSV could not be detected on the mucosal surface. Initially, HSV-2 was resistant to acyclovir but sensitive to foscarnet. After 1 month of topical treatment, HSV-2 became sensitive to acyclovir and was still sensitive to foscarnet. Finally, after 6 weeks of treatment, no virus could be detected by culture. CONCLUSION: Topical foscarnet (2.4%) is a convenient treatment for chronic genital herpes. Resistance to acyclovir disappears few weeks after stopping this drug and sensitivity to foscarnet persists during the 50 days of treatment.

Acyclovir↗
PubMed2001

Absence of rapid selection for acyclovir or penciclovir resistance following suboptimal oral prodrug therapy of HSV-infected mice.

BACKGROUND: Acyclovir (ACV) resistant herpes simplex virus (HSV) isolates can be readily selected in animal infection models receiving suboptimal ACV treatment, however no comparative studies of the emergence of resistance following suboptimal treatment with valacyclovir (VCV) or famciclovir (FCV), the prodrugs of acyclovir and penciclovir, respectively, have been reported. METHODS: Mice (n = 30) were infected with HSV type 1 or 2 in the ear pinnae and administered oral prodrugs at one fifth a dose previously shown to be effective. To select and amplify drug-resistant HSV, a total of seven consecutive in vivo passages with suboptimal treatment were performed for each virus sample and progeny virus from each passage was characterized by the plaque reduction (PRA) and plating efficiency assays (PEA). RESULTS: No drug-resistant HSV-2 and only a single drug-resistant HSV-1 variant were identified. Virus recovered from the first three sequential passages of this HSV-1 sample was susceptible by PRA, although the proportion of resistant virus recovered gradually increased upon passage. The resistant HSV-1 phenotype was confirmed by PRA after four sequential passages in mice. Unexpectedly, this in vivo-selected drug-resistant HSV-1 failed to yield an infection completely refractory to treatment in subsequent passages. CONCLUSIONS: Sub-optimal therapy of immunocompetent mice with either VCV or FCV did not readily select for HSV-mutants resistant to either ACV or PCV, suggesting that selection of resistance with either prodrug remains difficult using this system. Futhermore, this study suggests that the PEA may represent a useful adjunct to the PRA for monitoring alterations in the proportion of drug-resistant virus even when no change in IC50 is apparent.

Acyclovir↗
PubMed1999

Antiinfectives update: focus on treatment and prevention of viral and associated infections.

OBJECTIVE: To review the clinically significant antiinfectives approved by the Food and Drug Administration (FDA) since 1996, with an emphasis on agents used for treatment, prevention, or suppression of infection in immunocompromised individuals. DATA SOURCES: A MEDLINE search covering November 1994 to March 1998 was conducted to identify all antiinfectives (new medications and old medications with new indications) and the pertinent literature for review. The search was updated in August 1998 and supplemented with an FDA listing of approved drugs to enhance completeness. STUDY SELECTION: Clinically relevant studies were selected to highlight specific points about each medication. Preclinical publications were used when sufficient information was not available from clinical trials and this information was needed for clinical practice. CONCLUSIONS: Several new and promising antiretroviral agents (stavudine, lamivudine, saquinavir soft-gel capsules, nelfinavir, efavirenz) have been approved, which may allow more options to control HIV viremia. New options for treatment, prevention, and suppression of infections in immunocompromised individuals include azithromycin, cidofovir, famciclovir, valacyclovir, and itraconazole suspension. Liposomal-based amphotericin products may be associated with less toxicity than conventional amphotericin B; however, superior efficacy has not been proven.

AIDS-Related Opportunistic Infections↗
PubMed2000

Several options for antiviral treatment trials in multiple sclerosis--but which targets should be selected?

Involvement of viruses in the pathogenesis of multiple sclerosis (MS) is a long-lived hypothesis, which is has not yet been proven nor refuted. This is partly due to difficulties in the evaluation of diagnostic findings on persistent infections by common viruses such as herpesviruses and endogenous retroviruses. Progress in antiviral treatment of central nervous system (CNS) herpesvirus infections has stimulated controlled trials of long-term therapy with acyclovir and valacyclovir in MS, but conclusive results are not yet available. Other treatment possibilities might include anti-retroviral therapy, as well as attempts to counteract the effects of viruses in triggering attacks of MS following upper respiratory tract infections. Before such trials are initiated, however, further diagnostic evidence of the involvement of target viruses seems warranted.

Antiviral Agents↗
PubMed1999

Recent advances in varicella-zoster virus infection.

Varicella-zoster virus has developed a complex strategy that allows it to remain latent in the body and avoid destruction by the immune system. Although varicella and zoster have been recognized since antiquity, several new clinical syndromes--including chronic chickenpox with persistent verrucous lesions and disseminated varicella without skin lesions--have been noted in patients with AIDS. Acyclovir has been the mainstay for treating severe varicella-zoster virus infections; however, newer antiviral agents, including valacyclovir and famciclovir, have expanded therapeutic options for treating adults with herpes zoster. The recently licensed live attenuated vaccine for varicella-zoster virus is effective in preventing chickenpox, and the vaccine's ability to stimulate immunity in seropositive adults suggests a promising strategy with which to modify the course of herpes zoster.

Adult↗
PubMed2000

[Clinical manifestations of the subfamily alpha-herpesvirinae in childhood].

Herpes simplex virus(HSV) and varicella-zoster virus(VZV) belonging to the subfamily of alpha-herpesvirinae have the capacity to establish latent infection in neural tissues and to reactivate from these sites. HSV infection is characterized by a vesicular eruption, fever, and other constitutional symptoms but frequently inapparent both in primary and recurrent infections. However, the infection produces a wide spectrum of illness ranging from the trivial fever blisters to the most severe fatal sporadic encephalitis and neonatal infection. In contrast, VZV develops varicella, a common contagious disease of childhood during primary infection and zoster by reactivation of latent virus acquired during varicella. In normal children, the systemic symptoms of both diseases are mild, whereas serious complications are often observed in children with deficiencies in cell-mediated immunity. Acyclovir has been the drug of choice for treatment of severe infection with HSV and VZV for approximately 2 decades. Now, two new agents, valacyclovir and famciclovir will supplant acyclovir for certain indications.

Alphaherpesvirinae↗
PubMed2000

Management of herpes zoster (shingles) and postherpetic neuralgia.

Herpes zoster (commonly referred to as "shingles") and postherpetic neuralgia result from reactivation of the varicella-zoster virus acquired during the primary varicella infection, or chickenpox. Whereas varicella is generally a disease of childhood, herpes zoster and post-herpetic neuralgia become more common with increasing age. Factors that decrease immune function, such as human immunodeficiency virus infection, chemotherapy, malignancies and chronic corticosteroid use, may also increase the risk of developing herpes zoster. Reactivation of latent varicella-zoster virus from dorsal root ganglia is responsible for the classic dermatomal rash and pain that occur with herpes zoster. Burning pain typically precedes the rash by several days and can persist for several months after the rash resolves. With postherpetic neuralgia, a complication of herpes zoster, pain may persist well after resolution of the rash and can be highly debilitating. Herpes zoster is usually treated with orally administered acyclovir. Other antiviral medications include famciclovir and valacyclovir. The antiviral medications are most effective when started within 72 hours after the onset of the rash. The addition of an orally administered corticosteroid can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia. Ocular involvement in herpes zoster can lead to rare but serious complications and generally merits referral to an ophthalmologist. Patients with postherpetic neuralgia may require narcotics for adequate pain control. Tricyclic antidepressants or anticonvulsants, often given in low dosages, may help to control neuropathic pain. Capsaicin, lidocaine patches and nerve blocks can also be used in selected patients.

Acyclovir↗
PubMed2001

Varicella zoster virus. Recent advances in management.

OBJECTIVE: To provide an update on strategies for managing varicella zoster virus (VZV) and for preventing and treating established postherpetic neuralgia (PHN). QUALITY OF EVIDENCE: Treatment guidelines are based on randomized clinical trials. Recommendations concerning other aspects of VZV management (e.g., vaccination) are based mainly on expert opinion. MAIN MESSAGE: Varicella and herpes zoster caused by VZV can give rise to serious morbidity and mortality and should be treated. For preventing chickenpox, safe and effective immunization is widely recommended. Treating varicella-exposed seronegative pregnant women requires special attention because the virus can harm expectant mothers, fetuses, and newborns. The antiviral drugs, acyclovir, valacyclovir, and famciclovir, have been approved for treating herpes zoster and have a role in reducing the duration of PHN. Established PHN can be managed with analgesics, tricyclic antidepressants, and other agents. CONCLUSION: Vaccination and antiviral and other systemic agents can substantially reduce the morbidity associated with VZV infection.

Antiviral Agents↗
PubMed2002

[Molecular mechanisms on drug transporters in the drug absorption and disposition].

The membrane transport processes of drugs are critical issues to determine their absorption, distribution and elimination. Recently, various drug transporters have been identified and characterized. The enterocyte peptide transporter PEPT1 mediates the absorption of peptide-like drugs including beta-lactam antibiotics as well as valacyclovir lacking peptide bond. In the kidney, the basolateral organic anion transporters (OAT1, OAT3) and cation transporters (OCT1, OCT2) mediate renal distribution of hydrophilic anionic and cationic drugs, respectively. The brush-border type OAT-K1/K2 were suggested to be a target transporter for methotrexate-leucovorine rescue therapy. The ATP-driven efflux pump P-glycoprotein appeared to be an interaction site between digoxin and clarithromycin or itraconazole in the kidney. In addition, the intestinal P-glycoprotein was suggested to act as an absorptive barrier for tacrolimus in recipients of liver and small bowel transplantation.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMedDate not supplied

Adenovirus-mediated thymidine kinase gene therapy for recurrent ovarian cancer: expression of coxsackie-adenovirus receptor and integrins alphavbeta3 and alphavbeta5.

OBJECTIVE: Ten patients with recurrent ovarian cancer received a combined treatment of optimal tumor debulking, adenovirus-mediated herpes simplex virus thymidine kinase gene therapy (GT), and systemic application of acyclovir or valacyclovir and topotecan. Biopsies were taken at the time of secondary debulking about 1 month after the application of GT and chemotherapy and were analyzed for expression of coxsackie-adenovirus receptor (CAR) and integrins alphavbeta3 and alphavbeta5 with respect to treatment response. METHODS: Treatment modalities and study design have been described recently. Immunohistochemistry was used to visualize expression of CAR and integrins alphavbeta3 and alphavbeta5 in tumor samples taken before and after application of GT. RESULTS: Before GT six of ten patients presented with CAR-positive and four with CAR-negative tumors. After GT all tumors showed CAR expression. Integrin alphavbeta3 was found in all tumors before and after GT. Expression of integrin alphavbeta5 was seen in eight of ten tumor samples before GT and in all samples after GT. CONCLUSION: Despite the importance of CAR and integrin expression for successful adenovirus internalization, other cell surface receptors might be involved in this process. It is too early to decide whether expressions of CAR and integrin alphavbeta3/alphavbeta5 on tumor cells are appropriate additional inclusion criteria for the enrollment of patients in GT trials. Further research is necessary to evaluate the effect of GT plus chemotherapy on CAR and integrin expression.

Adult↗
PubMed2002

Evaluation and management of herpes zoster ophthalmicus.

Herpes zoster ophthalmicus occurs when the varicella-zoster virus is reactivated in the ophthalmic division of the trigeminal nerve. Herpes zoster ophthalmicus represents up to one fourth of all cases of herpes zoster. Most patients with herpes zoster ophthalmicus present with a periorbital vesicular rash distributed according to the affected dermatome. A minority of patients may also develop conjunctivitis, keratitis, uveitis, and ocular cranial-nerve palsies. Permanent sequelae of ophthalmic zoster infection may include chronic ocular inflammation, loss of vision, and debilitating pain. Antiviral medications such as acyclovir, valacyclovir, and famcidovir remain the mainstay of therapy and are most effective in preventing ocular involvement when begun within 72 hours after the onset of the rash. Timely diagnosis and management of herpes zoster ophthalmicus. with referral to an ophthalmologist when ophthalmic involvement is present, are critical in limiting visual morbidity.

Acyclovir↗
PubMed1993

[Varicella: how and when to start antiviral treatment].

The Meeting "An Update on Chickenpox" (Florence, 19-3-1993) has contributed to verify, in the light of the most recent acquisitions, the new guidelines for a correct rationale in the diagnosis and therapy of chickenpox. The present availability of an effective specific antiviral therapy for chickenpox (acyclovir) leads to a careful selection of patients to be treated. The high incidence of chickenpox morbidity keeps long unaltered and, beyond the usually benign onset of the primary infection in the child, the severity of this pathology in particular subjects and situations at risk is to be certainly underlined. Treatment is suggested for cases of chickenpox contracted inside the family. Generally, boys are at higher risk. Adolescents and adults, usually with a lower incidence, report a much higher severity of the acute onset and complications. Another category to be certainly treated is the one--in constant increase--of immunocompromised subjects. In any case, acyclovir treatment improves the symptomatologic evolution (pruritus and fever) and duration of clinical course. Among the progenitors of acyclovir, Valacyclovir seems to have the best prospects of success for the immediate future of antiviral therapy.

Acyclovir↗
PubMedDate not supplied

Cost-consequence models for varicella-zoster virus infections.

Three cost-consequence models were developed for treatment of infections due to varicella-zoster virus (VZV) with acyclovir in immunocompetent patients--adult- and childhood-onset chickenpox, and herpes zoster (shingles) in adults. For chickenpox, separate models allow examination of differences in severity and impact of the disease for children and adults, as well as in the management of civilians and adults in military service. Each model includes direct medical costs, indirect costs and health-related productivity loss, symptom and quality of life impact, and model assumptions and conclusions. Alternatives of treatment and no treatment are addressed. Quality of life impact is conceptualized in terms of a quality-adjusted life-days decrement due to VZV symptoms of importance to the patient, such as pain, rash, and itching. As experience and data become available, alternative agents such as valacyclovir and famciclovir for the treatment of patients with herpes zoster should be included in the modeling process.

Acyclovir↗
PubMed1996

Efficacy of famciclovir in the treatment of herpes zoster.

Although vidarabine was the first systemic antiviral drug for the treatment of acute herpes zoster, the agent now used most frequently is acyclovir, a far safer drug that became available a decade ago. However, even with widespread use of acyclovir, postherpetic neuralgia (PHN) remains a principal cause of postinfectious morbidity. Newer antiviral agents, such as famciclovir and valacyclovir, have recently been introduced for the treatment of uncomplicated herpes zoster. In a double-blind, randomized study, 500 mg of famciclovir three times daily for 7 days was compared with placebo; in a second study, 500 mg of famciclovir three times daily for 7 days was compared with 800 mg of acyclovir five times daily for 7 days. Famciclovir significantly reduced duration of viral shedding (P = 0.0001) and accelerated lesion resolution compared with placebo. Famciclovir was comparable to acyclovir for these acute parameters. Most importantly, famciclovir recipients lost PHN two times faster than those receiving placebo (P = 0.02 all patients; P = 0.004 patients > or = 50 years) resulting in a reduction in the median duration of PHN (56 days all patients; 100 days patients > or = 50 years). This reduction translated to a 3.5-month reduction in the median duration of PHN for patients 50 years or older, those at greatest risk for developing the most common complication of herpes zoster. Famciclovir 500 mg administered three times a day for 7 days is an effective and well-tolerated treatment for acute herpes zoster, and is the only oral antiviral agent proven to reduce the duration of PHN when administered during acute zoster infection.

2-Aminopurine↗
PubMedDate not supplied

[Genital herpes with special emphasis on perinatal herpes simplex virus infection].

INTRODUCTION: The incidence of genital herpes is increasing worldwide and at present herpes simplex virus type 2 is the most common cause of genital ulceration all over the world. CLASSIFICATION: The International Herpes Management Forum (IHMF) was established in 1993, suggesting a new classification of genital herpes: primary genital herpes, non-primary genital herpes, recurrent genital herpes, first episode genital herpes, atypical genital herpes and asymptomatic HSV (herpes simplex virus) infection. DIAGNOSIS: Clinical diagnosis of genital herpes should be confirmed by laboratory techniques, whereas a positive HSV culture is the best test for confirming the clinical diagnosis. Serological testing, including Western blot assay, is not the method of choice for diagnosis genital herpes. THERAPY: Management of patients with genital herpes must include various antiviral drugs (acyclovir, valacyclovir, famiclovir), but also must take into consideration the patients' clinical and emotional issues. Patients with few recurrences are best managed with episodic antiviral therapy, but those with more frequent recurrences may find a long term suppressive therapy more beneficial. Herpes simplex virus is acquired during labor in about 90% of neonatal herpes virus cases with direct contact with infected maternal genital secretions, in 5% of cases in utero (ascending infection or transplacentary) and in another 5% of cases HSV is acquired post partum. Herpes simplex virus infection includes skin infection, eye and mouth manifestations, CNS diseases and disseminated disease with multiorgan involvement. CONCLUSION: In order to reduce the risk of HSV transmission to the infant IHMF has suggested management of pregnant women with primary genital herpes: delivery by Caesarean section between 34th week and term. Acyclovir treatment may reduce the viral load at delivery, but before this can generally be recommended, more data are still required.

Female↗