[CLINICAL EFFICIENCY OF CYCLOFERON IN CHILDREN AND ADULTS WITH HIV AND/ OR HERPES INFECTION: SYSTEMATIC REVIEW AND META-ANALYSIS].

Aim was to estimate and compare clinical efficiency of cycloferon use against basic therapy in treatment of HIV and/ or herpes infection. There were comparisons of treatment results with patient (n=1274) groups' heterogeneity taken into account. 9 randomized clinical trials with cycloferon efficacy data were mobilized, in all studies there were protocols of injections, tablets or liniments cycloferon administration. Homogeneous and symmetric groups combination during meta-analysis increased statistic power of comparisons and led to integrative efficiency assessment, proved its' stability in statistic models. Cycloferon use in children and adults with HIV and/ or herpes infection was more the 3 times more effective to provide stable remission and exacerbation frequency diminish against basic therapy.

Successful treatment of iatrogenic multicentric Castleman's disease arising due to recrudescence of HHV-8 in a liver transplant patient.

We describe the case of a 59-year-old HIV-negative male who developed multicentric Castleman's disease (MCD) 1 year postliver transplantation due to recrudescence of a pretransplant human herpesvirus-8 (HHV-8) infection. He presented with fevers, dry cough, weight loss and drenching night sweats. Routine investigations were all unremarkable. Computerized axial tomography (CT) scans showed splenomegaly and intra-abdominal lymphadenopathy, confirmed by positron emission tomography. Cervical lymph node biopsies were consistent with MCD. The presence of HHV-8 was confirmed on immunohistochemistry. Peripheral blood HHV-8 quantitative polymerase chain reaction (qPCR) monitoring showed a threefold decrease in viremia in the first week of treatment with ganciclovir but had little impact on clinical symptoms. Reducing immunosuppression and switching to rituximab resolved clinical symptoms and produced a negative HHV-8 qPCR result. Retrospective molecular testing of sera collected pre- and immediately posttransplantation confirmed preexisting HHV-8 in the host. This is the first reported case of an HIV-negative postliver transplant patient developing MCD that manifested as posttransplant lymphoproliferative disorder due to recrudescence of HHV-8. We propose (1) the introduction of the term iatrogenic Castleman's disease (CD) for this and similar cases, (2) rituximab should be considered as a treatment option for CD and (3) consideration be given to a change to the World Health Organization classification of CD to incorporate such cases.

Recent developments in anti-herpesvirus drugs.

Background Herpesviruses notably establish lifelong infections, with latency and reactivation. Many of the known human herpesviruses infect large proportions of the population worldwide. Treatment or prevention of herpes infections and recurrent disease still pose a challenge in the 21st century. Sources of data Original papers and review articles, meeting abstracts, a book (Clinical Virology; DD Richman, RJ Whitley & FG Hayden eds) and company web sites. Areas of agreement For herpes simplex types 1 and 2 and for varicella zoster, acyclovir (ACV; now increasingly replaced by its prodrug valacyclovir, VACV) and famciclovir (FCV) have greatly reduced the burden of disease and have established a remarkable safety record. Drug-resistance, in the otherwise healthy population, has remained below 0.5% after more that 20 years of antiviral use. In immunocompromised patients, drug resistance is more common and alternative drugs with good safety profiles are desirable. For human cytomegalovirus disease, which occurs in immunocompromised patients, ganciclovir and increasingly its prodrug valganciclovir are the drugs of choice. However, alternative drugs, with better safety, are much needed. Areas of controversy Various questions are highlighted. Should the new 1-day therapies for recurrent herpes labialis and genital herpes replace the current standard multi-day therapies? The marked differences between VACV and FCV (e.g. triphosphate stability, effect on latency) may not yet be fully exploited? Do current antivirals reduce post-herpetic neuralgia (PHN)? For immunocompromised patients with varicella zoster virus (VZV) disease, should the first-line treatment be FCV, not ACV or VACV? Should there be more support to explore new avenues for current antivirals, for example in possibly reducing herpes latency or Alzheimer's disease (AD)? Should primary Epstein-Barr virus (EBV) disease in adolescents be treated with antivirals? How can new compounds be progressed when the perceived market need is small but the medical need is great. FCV was reclassified from prescription-only to pharmacist-controlled for herpes labialis in New Zealand in 2010; should this be repeated more widely? This article reviews new drugs in clinical trials and highlights some of the problems hindering their progress.

Current Perspectives on the Management of Herpesvirus Infections in Solid Organ Transplant Recipients.

Solid organ transplant recipients (SOTRs) are at high risk of human herpesvirus (HHV)-related morbidity and mortality due to the use of immunosuppressive therapy. We aim to increase awareness and understanding of HHV disease burden in SOTRs by providing an overview of current prevention and management strategies as described in the literature and guidelines. We discuss challenges in both prevention and treatment as well as future perspectives.

Verrucous herpetic infection of the scrotum and the groin in an immuno-competent patient: Case report and review of the literature.

Atypical presentations of genital herpes are more commonly described among immuno-compromised patients. Furthermore, verrucous lesions may be attributed to acyclovir resistant strains of herpes simplex virus as well as co-infection with fungi and other viruses in this patient population. We describe the first case of verrucous genital herpes infection in an immuno-competent patient.

Herpes simplex virus: it's more than a cold sore.

Herpes simplex virus (HSV) is a common office problem and may be trivialized as "just a cold sore." HSV infections may cause great concern to the otherwise healthy patient due to psychosocial issues and may lead to morbidity and mortality in certain populations. This article discusses clinical presentation, diagnosis, and management of orolabial/genital herpes and presents answers to questions frequently posed to primary care providers and specialists.

Antiviral therapies in children: has their time arrived?

The increase in the number and classes of antiviral agents that has occurred since the 1980s is remarkable. The rapid expansion in therapeutic options for previously untreatable illnesses challenges clinicians to gain familiarity and experience with these new drugs, especially with regard to their use in children. This article describes the clinical utilities, pharmacokinetics, and adverse effects of these new drugs to empower practitioners to use them appropriately.

[Arguments favouring the pharmacotherapy of Bells' palsy]. / Vóór medicamenteuze behandeling van Bell-paralyse.

Some clinicians claim a spontaneous complete recovery of facial nerve function after Bell's palsy in more than 80% of patients. However, for elderly patients and patients with a severe paresis/paralysis this is not the case. The main cause of Bell's palsy is probably reactivation of latent herpes viruses. Recent literature supports treatment with corticosteroids and antiviral medication, inhibiting viral replication and reducing oedema in the bony canal of the facial nerve. Using this medication in the first days of the disease provides a further 15% of patients with a good outcome in addition to the ones that improve spontaneously. Therefore, prednisone and valacyclovir are recommended for all patients with Bell's palsy and severe dysfunction, i.e. House-Brackmann facial grading scale IV, V and VI.

Importance of concomitant viral infection during late acute liver allograft rejection.

We have determined accompanying events and reviewed the management and outcome of late acute cellular rejection episodes in 384 consecutive liver recipients. A significant proportion of patients experienced concomitant viral infection (group 1, n = 15 [41%]), with CMV infection comprising the largest group and smaller contributions from other viruses (CMV, 30%; HSV, 5%; EBV, 3%; varicella zoster virus, 3%). Thirteen (35%) patients (group 2) developed late rejection associated with low maintenance immunosuppression, and in a further 10 patients (group 3), no accompanying factor could be identified. Refractory rejection was higher in late compared with early rejection episodes in our series (29% vs. 9.2%, P < 0.05). Antiviral chemotherapy administered in rejection episodes with concomitant viral infection, either as sole treatment in cases with accompanying hepatitis or as adjunctive therapy to further supplemental immunosuppression in episodes of steroid-resistant rejection, controlled the rejection process in all treated patients.

Is atherosclerosis an infectious disease?

Atherosclerotic coronary artery disease is multifactorial, but several lines of evidence implicate infection as a potential contributing factor. Chlamydia pneumoniae has the most compelling data, with Helicobacter pylori and cytomegalovirus also implicated. Clinical trials of antibiotics to decrease coronary events are underway. Until the results are available, however, we advise against prescribing antibiotics for this purpose.

[HHV 8 positive Castleman's disease and auto-immune neutropenia in 2 HIV-infected patients]. / Maladie de Castleman HHV 8 positive et neutropénie auto-immune chez 2 patients infectés par le VIH.

INTRODUCTION: Castleman's disease (CD) is a polyclonal lymphoplasmacytic and vascular proliferation prominent in lymphoid tissues, associated to Human Herpesvirus 8 (HHV-8) in Human Immunodeficiency Virus (HIV)-infected patients. The presence of autoimmune stigmates is frequent. EXEGESIS: We report two cases of neutropenia secondary to IgG neutrophil autoantibodies, indeterminate specificity, occurring in two HIV-infected patients with CD HHV-8+, treated by vinblastine since several years. The neutropenia was associated to other biologic stigmates of autoimmunity and the evolution has been complicated by several infections. Granulocyte-colony stimulating factor (G-CSF) and polyvalent immunoglobulin permitted a transient and low increase of neutrophila in one case. CONCLUSION: Auto-immune neutropenia in CD is rare and difficult to treat in our cases. This evolution is independent of relapse of CD. The immunoglobulin and G-CSF may be transitory effective.

[Herpetic meningitis in the child]. / Méningite herpétique chez l'enfant.

UNLABELLED: In children, viral meningitis is usually caused by Enteroviruses. Herpes simplex viruses (HSV) are known to be a cause of meningo-encephalitis. HSV-2 has been reported to cause recurrent meningitis (Mollaret's meningitis) in adults. CASE REPORT: We report the case of a three-year-old girl with HSV-1 meningitis, whose evolution with treatment by aciclovir was good. CONCLUSION: HSV-1 has rarely been reported as a cause of isolated aseptic meningitis in children. Primary phase of herpes simplex virus infection is not usually associated with neurologic complications.

An update on the herpesviruses.

An increasingly significant cause of disease in the immunodeficient patient, herpesviruses continue to be a concern in dentistry. Today's dentist must be aware of infections caused by CMV and EBV as well as HSV and VZV. Human herpesviruses 6 and 7 are not yet associated with a particular oral disease, but 80 percent to 90 percent of patients can be expected to shed these viruses in their saliva. Most recently, a new herpesvirus, HHV-8, was postulated associated with Kaposi's sarcoma. An update of information related to the diagnosis, prevention and treatment of herpesvirus infections is presented.

[Prevention and therapeutical trials of a few current viral diseases]. / Prévention et essais thérapeutiques de quelques viroses d'actualité.

Vaccines afford now good prevention of many viral diseases including Hepatitis B. In revenge, attempts of immunization against Herpes Virus types I and II did not result in large scale application of vaccination. Research for a vaccine against HIV encounters many difficulties due to virus variability and host reactions. The introduction of nucleosides analogues represented a great advance for antiviral chemotherapy. Weakly toxic drugs although efficacious against Herpes Virus replication are now available but they do not seem to prevent viral recurrences. As for HIV, its sensitivity to drugs like AZT has raised great hopes which were limited by their intrinsic toxicity. However, research and trials for more efficacious but less toxic drugs are further being developed.

Treatment of viral conjunctivitis with antiviral drugs.

Viral conjunctivitis is one of the most common disorders observed in ophthalmic emergency departments, yet no established treatment exists. Lately, antiviral medications have been introduced into clinical practice; however, a systematic review focusing on their use and effectiveness in the treatment of viral conjunctivitis has not been previously reported. We systemically reviewed the literature to identify studies where antiviral drugs were used to treat viral conjunctivitis. Currently, aciclovir, trifluridine and valaciclovir are commonly used as antiviral agents to treat herpesvirus infections. Cidofovir has been used successfully to treat some cases of adenoviral conjunctivitis, although toxicity has also been reported. The use of other medications, such as idoxuridine, has been minimized in clinical practice due to their high toxicity. Interestingly, most of the antiviral drugs developed are used to treat herpesvirus infections, while less progress has been made in the field of adenoviral infections. For other viral causes of conjunctivitis, no effective remedy is currently available, and treatment focuses on the relief of symptoms. Caution should be exercised when coadministering other pharmacological agents, such as corticosteroids, because of emerging adverse effects.

Famciclovir: a focus on efficacy and safety.

IMPORTANCE OF THE FIELD: Famciclovir is the prodrug of penciclovir, a guanosine analogue that inhibits viruses of the alpha sub-family of the Herpesviridae, as well as hepatitis B virus. It is indicated for management of mucocutaneous herpes simplex virus disease and acute herpes zoster, and has been investigated for management of hepatitis B virus infection. AREAS COVERED IN THIS REVIEW: Data for this review were identified by searches of papers published in English on Medline and Scopus, spanning the years 1975 through 1 February 2010 with the key words: 'famciclovir', 'famvir', 'penciclovir', 'herpes', 'oral', 'genital', 'varicella', 'zoster' and 'virus' in association with 'safety', 'toxicity', 'tolerability', 'efficacy' and 'indications'. Relevant references were also obtained from articles acquired through the search strategy. WHAT THE READER WILL GAIN: Readers are also provided with up-to-date information on the use of famciclovir for infections due to herpes simplex, varicella zoster and hepatitis B viruses. Clinical data pertaining to the safety and tolerability of famciclovir are also reviewed. TAKE HOME MESSAGE: Famciclovir is a safe, convenient, and well-tolerated drug when used for its approved indications. The most common side effects indicated in the majority of studies were headache and nausea. Data for its use in childhood and pregnancy are limited.