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Original ArticleFree PreviewArchive

Acyclovir Halts Progression of Herpes Zoster in Immunocompromised Patients

List of authors.
  • Henry H. Balfour, Jr., M.D.,
  • Bonnie Bean, M.D.,
  • Oscar L. Laskin, M.D.,
  • Richard F. Ambinder, M.D.,
  • Joel D. Meyers, M.D.,
  • James C. Wade, M.D.,
  • John A. Zaia, M.D.,
  • Dorothee Aeppli, Ph.D.,
  • L. Edward Kirk,
  • Anthony C. Segreti, Ph.D.,
  • Ronald E. Keeney, M.D.,
  • and the Burroughs Wellcome Collaborative Acyclovir Study Group*

Abstract

We conducted a placebo-controlled, double-blind study of acyclovir therapy for acute herpes zoster in immunocompromised patients. Of the 94 patients enrolled in the study, 52 had localized skin lesions at entry, and 42 had disseminated cutaneous zoster. A one-week course of intravenous acyclovir (1500 mg per square meter of body-surface area per day) halted progression of zoster in both groups, as determined by development or progression of cutaneous dissemination, development of visceral zoster, or proportion of cases deemed treatment failures. Significantly fewer patients treated with acyclovir within the first three days after the onset of exanthem had complications of zoster, as compared with patients treated with placebo (P = 0.02 by Fisher's exact test), but acyclovir also stopped progression of zoster in patients treated after three days of rash (P = 0.05 by Fisher's exact test). Acyclovir recipients with disseminated cutaneous zoster had a significantly accelerated rate of clearance of virus from vesicles, as compared with placebo recipients (P = 0.05 by the Breslow test). (N Engl J Med 1983; 308:1448–53.)

Funding and Disclosures

Supported by grants from Burroughs Wellcome Co. and from the National Institutes of Health (AM 18883, AI 07044, AI 15689, CA 18029, CA 30924, and CA 15396).

* The study group includes the following physicians: F. Aoki, University of Manitoba, Winnipeg; A. Chow, University of British Columbia, Vancouver; L. Corey, University of Washington, Seattle; D. Durack. Duke University Medical Center, Durham, N.C.; L. Gelb, Washington University, St. Louis; L. Gutman, Duke University, Durham, N.C.; J. Hamilton, Veterans Administration Hospital, Durham, N.C.; G. Hammond, University of Manitoba, Winnipeg; J. Joncas, St. Justine's Hospital, Montreal; M. Levin, Dana–Farber Cancer Institute, Boston; J. Marr, St. Louis University, St. Louis; J. Pagano, University of North Carolina, Chapel Hill; S. Plotkin, Children's Hospital of Philadelphia; C. Prober, Hospital for Sick Children, Toronto; P. Shackleford, Washington University, St. Louis; S. Starr, Children's Hospital of Philadelphia; R. Steele, University of Arkansas, Little Rock; M. Tarpay, University of Oklahoma Medical Center, Oklahoma City; and J. Whisnant, University of North Carolina, Chapel Hill.

Author Affiliations

From the University of Minnesota Health Sciences Center, Minneapolis; the Johns Hopkins University School of Medicine, Baltimore; the Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle; the City of Hope National Medical Center, Duarte, Calif.; and the Burroughs Wellcome Co., Research Triangle Park, N.C. Address reprint requests to Dr. Balfour at Box 437, Mayo Bldg., University of Minnesota Health Sciences Center, Minneapolis, MN 55455.

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