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Acyclovir for treatment of varicella in immunecompetent patients
1Department of Laboratory Medicine and Pathology, and Pediatrics, University of Minnesota Health Sciences Center, Minneapolis 55455.
Insights
Oral acyclovir effectively treats chickenpox (varicella) in immunocompetent individuals, reducing fever and speeding skin healing without adverse effects or impacting long-term immunity.
Area of Science:
- Virology
- Immunology
- Pediatrics
Background:
- Varicella (chickenpox) is a common childhood illness with potential for severe complications, including hospitalization and death, even in immunocompetent individuals.
- An estimated 4000-6000 healthy children are hospitalized annually in the U.S. for varicella.
- A significant mortality rate exists for immunocompetent individuals with varicella.
Purpose of the Study:
- To review and update progress on clinical trials investigating oral acyclovir for varicella treatment in immunocompetent patients.
- To evaluate the efficacy and safety of acyclovir in managing varicella symptoms and progression.
Main Methods:
- Review of three placebo-controlled, double-blind studies involving oral acyclovir in healthy children and adolescents.
- Analysis of a recent study on acyclovir's effects in 148 immunocompetent adults.
- Assessment of viral (VZV) antibody titers (ELISA, FAMA) one year post-infection.
Main Results:
- Oral acyclovir significantly reduced fever duration and height in children and adolescents.
- The drug accelerated cutaneous healing in both pediatric and adult immunocompetent populations.
- Acyclovir treatment did not affect VZV antibody titers one year after varicella infection.
- No adverse effects were reported with acyclovir use in the clinical trials.
Conclusions:
- Acyclovir is a proven beneficial treatment for varicella in immunocompetent individuals.
- The primary remaining clinical question concerns patient selection criteria for acyclovir therapy.
- Further discussion is warranted regarding the advantages and disadvantages of treating varicella with acyclovir.
Abstract:
Varicella, one of the most common childhood diseases, can cause significant morbidity and even mortality in immunecompetent persons. In the U.S. alone, an estimated 4000-6000 otherwise normal youngsters are hospitalized every year with an annual death rate for immunecompetent persons of 96. This article reviews and updates progress in clinical trials utilizing oral acyclovir for treatment of varicella in immunecompetent patients. Three placebo-controlled, double-blind studies of acyclovir in normal youngsters and adolescents found that the drug reduced the height and duration of fever and accelerated cutaneous healing without producing any adverse effects. Acyclovir did not diminish VZV antibody titers measured one year post-varicella by either ELISA or FAMA methods. A recent study in 148 immunecompetent adults demonstrated that acyclovir can significantly reduce fever and hasten cutaneous healing. Acyclovir is thus of proven benefit for treatment of varicella. The major issue remaining is who should be treated, and the pros and cons of this are discussed.