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Published on: December 18, 2012
Long-term valacyclovir suppressive treatment after herpes simplex virus type 2 meningitis: a double-blind, randomized
E Aurelius1, E Franzen-Röhl, M Glimåker
1Infectious Diseases Unit, Karolinska Institutet, [corrected] Karoliniska University Hospital, Stockholm, Sweden. elisabeth.aurelius@ki.se
Summary
Antiviral suppression with valacyclovir did not prevent recurrent herpes simplex virus type 2 meningitis. A rebound phenomenon may increase meningitis risk after stopping treatment, suggesting current dosages are inappropriate for central nervous system protection.
Area of Science:
- Neurology
- Infectious Diseases
- Virology
Background:
- Herpes simplex virus type 2 (HSV-2) frequently causes aseptic meningitis.
- Neurological complications of HSV-2 meningitis require further investigation.
Purpose of the Study:
- To evaluate the efficacy of antiviral suppression in preventing recurrent HSV-2 meningitis.
- To characterize the full spectrum of neurological complications associated with HSV-2 meningitis.
Main Methods:
- A prospective, placebo-controlled, multicenter trial involving 101 patients with HSV-2 meningitis.
- Patients received initial treatment followed by 1 year of either valacyclovir (0.5 g twice daily) or placebo.
- Follow-up for 2 years to assess meningitis recurrence and neurological outcomes.
Main Results:
- No significant difference in meningitis recurrence between groups during the first year.
- A significantly higher risk of recurrence in the second year (off-drug) for the valacyclovir group (HR, 3.29).
- One-third of patients experienced multiple meningitis episodes; considerable neurological morbidity was observed in both groups.
Conclusions:
- One-year suppressive valacyclovir treatment (0.5 g twice daily) is ineffective in preventing recurrent HSV-2 meningitis.
- The dosage may be insufficient for preventing HSV activation in the central nervous system.
- A potential rebound phenomenon increases meningitis risk after treatment cessation, and this regimen is not recommended for preventing HSV meningitis recurrence.
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