Valaciclovir Update

Bell, Andrew R.

doi:10.1007/978-1-4615-4743-3_14

Cited by 12 publications

(3 citation statements)

References 20 publications

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“…We knew that in individuals with HIV co‐infection treated with oral VACV in a dosage of 8 g/day, there is a 1.3 log reduction in plasma CMV viral load. Since this dose is associated with a significant decrease in the rate of infection‐related visceral complications, it was important for us to establish therapeutic blood levels in the fetus 20 . This modest reduction in CMV viral load may translate into significant clinical benefits if CMV replication is kept below a critical threshold value identified in natural history studies 32 .…”

Section: Discussionmentioning

confidence: 99%

“…One pregnant woman with a renal transplant who presented with fetal CMV demonstrated by PCR in amniotic fluid was treated with oral ganciclovir and subsequently delivered a healthy newborn 18 . ACV with a drug oral regimen of 4 g/day is active against CMV, and its prodrug valaciclovir (VACV) at a dose of 8 g/day has been shown to be even more effective against herpes viruses 19–22 in individuals infected with HIV. Additionally, VACV has been shown to have fewer adverse effects than ACV 19 .…”

Section: Introductionmentioning

confidence: 99%

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Maternal administration of valaciclovir in symptomatic intrauterine cytomegalovirus infection

Jacquemard¹,

Yamamoto²,

Jm³

et al. 2007

BJOG

198

119

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Objectives To report early experience with treatment of intrauterine cytomegalovirus (CMV) infection using maternal oral administration of valaciclovir (VACV).Design Observational study of fetuses infected with CMV with or without treatment with valaciclovir.Population Pregnancies with confirmed fetal CMV infection were treated with oral VACV (8 g/day).Main outcome measures Fetal viral load and drug concentration were monitored in amniotic fluid and in fetal blood. Data on the course and outcome of a group of untreated symptomatic fetuses infected with CMV are also reported.Results Therapeutic concentrations were achieved in maternal and fetal bloods. The viral load in the fetal blood (VLFB) decreased significantly after 1-12 weeks of treatment (Wilcoxon paired test P = 0.02). Twenty pregnancies including 21 fetuses were treated at 28 weeks (median, range: 22-34) for 7 weeks (median, range: 1-12). Ten infants were developing normally at between 1 and 5 years of age. Two infants (both aged 2 years) had severe isolated unilateral deafness. One neonate presented with microcephaly and severe deafness but was also diagnosed with incontinentia pigmenti. Six out of seven cases that eventually required termination of pregnancy (TOP) had evidence of in utero progression of the disease with worsening cerebral lesions. One fetus died in utero. The outcome of 14/24 (58.3%) untreated symptomatic infected fetuses was poor with either TOP, intrauterine fetal demise or severe congenital infection disease of the neonate; the remaining ten infants were healthy at follow up.Conclusion Maternal oral administration of VACV leads to therapeutic concentrations in the maternal and fetal compartments, with a decrease in VLFB. Our results suggest that in cases where TOP is declined, a randomised controlled trial to study this treatment option further is indicated.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Maternal administration of valaciclovir in symptomatic intrauterine cytomegalovirus infection

Jacquemard¹,

Yamamoto²,

Jm³

et al. 2007

BJOG

198

119

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“…Several large studies that have compared the 2 oral drugs in various clinical settings also suggested that there may be a clinical benefit to the improved bioavailability of valacyclovir. 10 Therefore, valacyclovir may have distinct advantages over acyclovir in the treatment of varicella in the immunocompromised patient, and oral acyclovir should not be relied on in this setting.…”

Section: Discussionmentioning

confidence: 99%

Varicella in a Pediatric Heart Transplant Population on Nonsteroid Maintenance Immunosuppression

Dodd

Burger

Edwards³

et al. 2001

Pediatrics

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ABSTRACT. Objective. Varicella-zoster virus has been reported to produce serious, often life-threatening, disease in immunosuppressed patients with a variety of diagnoses. The impact of this virus on the young child after heart transplantation has not been reported.Methods. We reviewed the charts of 28 children who were <10 years of age at heart transplantation and had at least 1 year of follow-up. The median follow-up period was 7 years (1.4 -13.0 years). All were seronegative for varicella-zoster virus before transplantation. Fourteen (50%) developed varicella at a median time posttransplantation of 3.3 years. The first 7 were admitted for intravenous acyclovir for 3 days followed by oral acyclovir for 7 days. The last 7 were treated as outpatients with oral valacyclovir for 7 days (n ‫؍‬ 6) or with oral acyclovir for 10 days (n ‫؍‬ 1).Results. Intravenous and oral regimens both were well tolerated and were without complications. No patient was receiving steroids at the time that they developed their initial episode of varicella. One patient was receiving steroids for therapy of posttransplantation lymphoproliferative disease when she developed recurrent varicella or generalized zoster. No episodes of rejection were attributed to the varicella-zoster virus infection. There were no episodes of localized zoster. All patients experienced seroconversion from undetectable to detectable antibody titers early after varicella, and 12 of the 14 patients continued to have persistent detectable titers in late follow-up. Two of the 14 who received chemotherapy or enhanced immunosuppression after retransplantation transiently lost detectable varicella-zoster virus antibodies but currently have detectable titers.Conclusions. Primary varicella-zoster infection was well tolerated in our young pediatric heart transplant recipients, with no serious complications. We now reserve inpatient/intravenous therapy for those who are unable to tolerate oral medications or those who are receiving enhanced immunosuppression. Pediatrics 2001; 108(5). URL: http://www.pediatrics.org/cgi/content/full/ 108/5/e80; heart transplantation, varicella, pediatric.ABBREVIATIONS. VZIG, varicella-zoster immune globulin.

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Antiviral Agents

Hosmane

2003

Kirk-Othmer Encyclopedia of Chemical Technology

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Since the discovery of the first virus >100 years ago, thousands of different viruses have been identified and characterized, and a number of plant, animal, and human ailments have been traced to viral origin. The rapid advances made in tools and techniques of molecular biology in the last 40 years, coupled with cooperative efforts in genetics and biochemical fronts, have afforded intricate details of the structure, function, replication, and genomic makeup of a host of viruses. As there are too many viruses to give even short accounts, this article focuses on only those that have some relevance to human diseases. But, since the list of all human viruses would still be too long to give detailed descriptions for each, the focus is further narrowed down to four major viruses that are currently perceived to threaten global health. These four viruses include HIV (human immunodeficiency virus, which causes AIDS), HBV and HCV (hepatitis B and C viruses that cause liver damage), and the more recent WNV (West Nile virus that causes brain inflammation). Nevertheless, an attempt has been made to classify all the known major viruses based on their shape, size, symmetry, hosts, and chemical composition that includes nucleic acid, protein, and presence or absence of lipid envelope. As they are a form of life that cannot replicate outside a host cell, viruses have evolved to develop complex and diverse interactions with higher organisms. Therefore, it was long believed that the development of antiviral agents that would specifically disrupt the viral replication process without affecting the normal metabolic events of the host would be difficult. Thanks to excellent advances in virology, several targets that are unique to the viruses have now been identified and successfully explored. This article briefly describes the general processes of viral infection to point out potential targets for selective antiviral agents. These targets are then classified into two major virus‐specific processes, including ( a ) early events of viral adsorption, penetration and uncoating, and ( b ) later synthetic events that concern intracellular replication of the virus. While there are only limited choices of candidates dealing with the early events, a much larger pool of candidates exists for targeting the later events in a virus life cycle, and they are known to be virus‐specific. The viruses synthesize and utilize specific enzymes and proteins, and more importantly, the replication of viral genomes is also virus‐specific. Nucleoside analogues which target these later events of viral life cycles have played major roles as antiviral agents against almost all the major viruses, and therefore, a special emphasis has been placed on this class of compounds in this review article. Prophylactic measures such as vaccine immunization have also been discussed under each of the four major viruses mentioned.

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Valaciclovir Update

Cited by 12 publications

References 20 publications

Maternal administration of valaciclovir in symptomatic intrauterine cytomegalovirus infection

Maternal administration of valaciclovir in symptomatic intrauterine cytomegalovirus infection

Varicella in a Pediatric Heart Transplant Population on Nonsteroid Maintenance Immunosuppression

Antiviral Agents

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