Document 0359
 DOCN  M9590359
 TI    Prophylaxis and treatment of opportunistic viral infections in patients
       with HIV infection.
 DT    9509
 AU    Mills J; Macfarlane Burnet Centre for Medical Research/National Centre
       in; HIV Virology Research, Fairfield, VIC.
 SO    Annu Conf Australas Soc HIV Med. 1994 Nov 3-6;6:134 (unnumbered
       abstract). Unique Identifier : AIDSLINE ASHM6/95291740
 AB    Reactivations of HSV infections are easily managed by treatment or
       chemosuppression with acyclovir (ACV); whether the ACV prodrug
       (valaciclovir) will be better for this indication is uncertain. Rare
       patients (prob. < 0.1% of those infected) will develop thymidine-kinase
       deficient, ACV-resistant strains of HSV that need to be treated
       topically with trifluridine (+/- interferon), or systemically with
       foscarnet (PFA). Better drugs for management of these strains are
       urgently needed. Reactivations of VZV infections are easily managed with
       oral or parenteral ACV. The ACV prodrug valaciclovir, and the related
       prodrug famciclovir, may be preferable for treatment. ACV (and covariant
       famciclovir) resistance is very unusual, and these infections can be
       managed with foscarnet in most cases. Chemosuppression is rarely needed.
       Reactivation of CMV infection occurs in 30-50% of patients with AIDS,
       generally when the CD4 counts are < 50/microliters. Currently
       reactivations are treated with a 2-week course of high-dose ganciclovir
       (GCV) or PFA, followed by life-long maintenance therapy. Although
       sustained suppression of CMV disease is achieved in most patients, these
       drugs are toxic, expensive, and require i.v. administration. Oral GCV
       will obviate need for intravenous administration, but the expense and
       toxicity problems will remain, and the efficacy may be below that of
       intravenous drug. Early clinical results with HPMPC suggest substantial
       toxicity and suboptimal efficacy; no efficacy data is yet available on
       cyclobut-G. Although a chemosuppression strategy would be useful for CMV
       infections, current drugs are unsatisfactory. High-dose ACV did not
       prevent CMV reactivation; whether valaciclovir will be effective awaits
       the results of ongoing ACTG study 204. Perhaps the best strategy, still
       not validated by extensive clinical trials, will be to anticipate
       imminent CMV infection through detection of CMV antigen in blood
       neutrophils, or CMV DNA in serum, and to institute pre-emptive therapy
       with the currently available drugs. This strategy has worked well in
       transplant recipients. However, there is still an urgent need for
       effective, non-toxic, orally-absorbed drugs active toward CMV.
 DE    Antiviral Agents/*THERAPEUTIC USE  AIDS-Related Opportunistic
       Infections/*PREVENTION & CONTROL  Cytomegalovirus Infections/*PREVENTION
       & CONTROL  Herpes Simplex/*PREVENTION & CONTROL  Herpes
       Zoster/*PREVENTION & CONTROL  Human  Virus Activation/DRUG EFFECTS
       MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).