Prolonged Continuous Acyclovir Treatment of Normal Adults With Frequently Recurring Genital Herpes Simplex Virus Infection

doi:10.1001/jama.1991.03460060079028

Prolonged Continuous Acyclovir Treatment of Normal Adults With Frequently Recurring Genital Herpes Simplex Virus Infection

Lisa G. Kaplowitz, MD;
David Baker, MD;
Lawrence Gelb, MD;
James Blythe, MD;
Ralph Hale, MD;
Philip Frost, MD;
Clyde Crumpacker, MD;
Sergio Rabinovich, MD;
James E. Peacock, Jr, MD;
James Herndon, MD;
L. Gray Davis, MS, PhD;
the Acyclovir Study Group

From the Medical College of Virginia, Virginia Commonwealth University, Richmond (Dr Kaplowitz); the State University of New York, Stony Brook (Dr Baker); Washington University School of Medicine (Dr Gelb) and St John's Mercy Medical Center (Dr Blythe), St Louis, Mo; the University of Hawaii, Honolulu (Dr Hale); Sinai Medical Center, Miami, Fla (Dr Frost); Beth Israel Hospital, Boston, Mass (Dr Crumpacker); Southern Illinois University School of Medicine, Springfield (Dr Rabinovich); Bowman Gray School of Medicine, Winston-Salem, NC (Dr Peacock); and Burroughs Wellcome Co, Research Triangle Park, NC (Dr Davis). Dr Herndon is in private practice in Dallas, Tex. The members of the Acyclovir Study Group are listed in the acknowledgments.

Abstract

In this 3-year study of suppressive acyclovir for recurrent genital herpes, patients with more than six recurrences per year were randomized initially to 400 mg of acyclovir or placebo orally two times per day, with recurrences treated with 200 mg of acyclovir five times per day for 5 days. In the second year of the study, all patients received acyclovir as a daily suppressive or intermittent acute therapy; in the third year, all received daily acyclovir. Among 525 patients completing 3 study years, 289 received 3 years of suppressive therapy and 236 received 1 year of acute therapy followed by 2 years of suppressive therapy. Of those who completed the third year, 61% were recurrence free that year; 25% of the suppressive therapy—only group were recurrence free for all 3 years. The annual recurrence rate dropped from more than 12 recurrences per year at baseline to 1.0 (suppressive therapy) and 1.4 (acute and suppressive therapy) recurrences during the third year. No significant toxic effects were detected. Daily suppressive acyclovir therapy was effective and well tolerated.

(JAMA. 1991;265:747-751)