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Patients obtained daily cultures of their perirectal, urethral, oral, and genital areas and kept dairy records of signs and symptoms of genital and oral-labial herpes.
Herpes simplex viruses are known to be among the most common disease-causing microorganisms. Their prevalence can exceed 90% depending on the socioeconomic status of the population. Since the number of immunocompromised patients has increased because of the increased incidence in the acquired immunodeficiency syndrome and an increase in organ transplantation, herpes virus infection may have a greater clinical significance. While treatment of otherwise healthy individuals will not usually cause any clinical problems herpes infection in an immunocompromised patient can have severe consequences. Additionally, development of viral resistance can be observed that may require alternative drugs in treatment. We present a case history of a man with a B-cell chronic lymphocytic leukemia that was associated with a very unusual herpes simplex virus infection in the nasal vestibule. Possible causes for the development of resistance in herpes infections and the use of famciclovir and forscarnet as two therapeutic alternatives to aciclovir are discussed.
Exacerbations of genital herpes coinciding with MS relapses suggest a potential link between the development of NABs and inhibition of anti-viral action of endogenous IFNβ. This case highlights that NABs not only decreases exogenous IFNβ treatment efficacy, but may also interfere with anti-viral properties of endogenous IFNβ. Investigating patients who are treated with biological medication will allow us to better understand the biology and signalling pathways in humans.
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Epstein-Barr virus is an ubiquitous member of the human herpes virus family. A specific antigen structure of the Epstein-Barr virus was discovered in the last decade. It was possible to diagnose some unusual clinical manifestations of EBV infections and its clinical course by different serologic analyses (immunofluorescent tests, immunoenzyme assay and polymerase chain reaction). This is very important in cases of atypical primary infections (hepatitis, meningoencephalitis), chronic mononucleosis and lymphoproliferative disorders and nasopharyngeal carcinoma. Famciclovir, a new antiviral agent (peroral form of penciclovir) may play an important role in the therapy of these infections.
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We carried out a survey of all UK genitourinary (GU) medicine clinics, via postal questionnaire, in order to evaluate the current management of recurrent genital herpes (RGH) in the GU medicine setting. Respondents were invited to answer questions regarding various aspects of herpes simplex virus (HSV) management. There was a 62% response rate. Analysis of the returned surveys revealed that the vast majority of clinics (96%) provided drug treatment for RGH, with 81% having a clinic policy for the management of genital herpes (GH). A majority (64%) of clinics had access to some type of counselling or psychological therapy and 47% encouraged collaboration with primary care for follow-up prescribing. Of the clinics providing drug therapy for RGH, 80% used aciclovir alone with smaller numbers having access to aciclovir, famciclovir and valaciclovir. While many clinics are meeting the British Association of Sexual Health and HIV (BASHH) guidelines, improvements can be made to increase the availability of psychological support to patients with HSV and improve links with primary care.
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This study demonstrated that, compared to episodic treatment, suppressive treatment with oral famciclovir may extend the time to symptomatic outbreaks in patients with frequent recurrences of genital herpes.
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Cats were treated orally with famciclovir (90 mg/kg; n = 10) or a similar volume of lactose (400 mg; 6) 3 times/d for 21 days. Cats were inoculated with FHV-1 and administered the first treatment dose on day 0. Disease score; weight; results of urinalysis, serum biochemical analysis, and CBC; histologic conjunctivitis score; herpetic DNA shedding; goblet cell density; anti-FHV-1 antibody concentration; and plasma penciclovir concentration were measured.
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The antiherpetic drugs acyclovir (ACV, valaciclovir) and penciclovir (famciclovir) are phosphorylated by viral thymidine kinase and terminate DNA synthesis. ASP2151 (amenamevir) and foscavir (PFA) directly inhibit viral helicase-primase and DNA polymerase, respectively, and inhibit replication of herpes simplex virus (HSV) and varicella-zoster virus. ACV, ASP2151, and PFA all inhibit HSV with a different mechanism of action and as a consequence, the kinetics of viral DNA accumulation and progeny virus production differ. This study focused on how viral DNA synthesis and its related events in the replication cycle would influence anti-HSV action of ACV, ASP2151, and PFA. ASP2151 suppressed HSV replication more efficiently than ACV at 10 × 50% effective concentration of plaque formation (EC50), when treatments were started 0-24 h after infection. ASP2151 and PFA were more potent than ACV in suppressing viral DNA synthesis and infectious virus production when they were added up to 3 h following infection. The virus replicated in the presence of ACV was compared for the ratios of HSV DNA copy number to infectivity with that without ACV and infectivity of ACV-treated virus was less efficient than that without ACV-treatment. The EC50 of infected cells in the time course after infection was preserved in PFA, limited in ASP2151, and much increased for ACV, indicating that viral DNA synthesis had little effect on antiviral action of PFA and ASP2151 but reduced the susceptibility of ACV. ASP2151 showed a preferable profile as an anti-herpetic agent with a better pharmacokinetic profile than ACV.
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Our data show that these devices release penciclovir with a burst of drug delivery until the tenth day of release, then at an average rate of 5.063 ± 1.704 μg per day through the next 50 days with near zero-order kinetics (in comparison to MED-4750-acyclovir devices, which show the same burst kinetics and average 2.236 ± 0.625 μg/day thereafter). Furthermore, these devices suppress primary infection of FHV-1 in a cell culture system.
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Wise use of new diagnostic assays for herpes simplex coupled with more convenient treatment regimens should provide better management of patients with genital herpes.
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To assess efficacy of two-stage treatment of severe genital herpes (GH) with regular recurrences: combined use of antivirus medicines with interferon preparations and its inductors followed by antirecurrence vaccine therapy.
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Famvir (famciclovir), manufactured by SmithKline Beecham Pharmaceuticals, has been shown to suppress herpes simplex virus (HSV) infections in people with HIV. Over a period of 4 months, 97 percent of patients treated with the drug did not experience any recurrences. The drug cleared the initial lesions, and most patients remained free of recurrences during the trial. Famvir was well tolerated, with diarrhea being the most commonly reported side effect. These findings could have a major impact on the quality of life for HIV and HSV co-infected patients. HIV patients often experience severe herpes infections, some causing potentially life-threatening complications. The company also sells a cream used for herpes cold sores and is developing an intravenous treatment for immunocompromised individuals, including those who have had chemotherapy for cancer.
The authors found variation in treatment modalities and recommendations by each health profession, despite the fact that patients reported similar triggers and concerns. This may be due to individual patient need and the health care professional's lack of knowledge.
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Nucleoside analogues such as lamivudine for chronic hepatitis B have an excellent safety profile while patients are on therapy but reactivation flares occur in 19-50% of patients after stopping therapy, some of whom develop liver decompensation.
Chronic hepatitis B-infected patients treated with either LAM (n=9, 150 mg daily for 12 weeks) or LAM plus FCV (n=12, 150 mg LAM daily plus 500 mg FCV daily for 12 weeks). Serial serum HBV DNA were determined. A mathematical model was applied to analyze the dynamics of viral clearance.
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Median healing times of primary (first to appear) vesicular lesions in the famciclovir single-dose, famciclovir single-day, and placebo groups were 4.4, 4.0, and 6.2 days, respectively. There was no significant difference between the famciclovir regimens. Adverse events in the famciclovir groups were similar to placebo.
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The duration of bortezomib therapy was 1 to 164 weeks (median, 16 weeks). The total duration of exposure to bortezomib was 4150 weeks (80 patient-years). Except for the occasional missed dose, the self-reported compliance with antiviral prophylaxis was 100%. Not a single episode of herpes zoster was reported during this period. No adverse effects were noted that could be definitely attributed to acyclovir, valacyclovir, or famciclovir.
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Presence of residual corneal scarring, visual acuity at the last visit, changes in corneal sensation, recurrence rate, and manifestations of HSK were assessed in patients receiving long-term prophylactic systemic acyclovir.
Several guanosine analogues, i.e. acyclovir (and its oral prodrug valaciclovir), penciclovir (in its oral prodrug form, famciclovir) and ganciclovir, are widely used for the treatment of herpesvirus (i.e. HSV-1, HSV-2, VZV and HCMV) infections. In recent years, several new guanosine analogues have been developed, including the 3-membered (cyclopropyl) sugar derivative A-5021 and the 6-membered D- and L-cyclohexenyl derivatives. Prominent features shared by all guanosine analogues are the following. They depend for their phosphorylation on the virus-encoded thymidine kinase (TK), which makes them particularly effective against those viruses (HSV-1, HSV-2 and VZV) that encoded for such TK. They are also active against HCMV, whether or not they are subject of phosphorylation by the HCMV-induced UL97 protein kinase. Their antiviral activity can be markedly potentiated by mycophenolic acid, an IMP dehydrogenase inhibitor, and they hold great promise, not only as antiviral agents for the treatment of herpesvirus infections, but also as antitumor agents for the combined gene therapy/chemotherapy of cancer, provided that (part of) the tumor cells have been transfected by the viral TK gene.
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Increased understanding of the clinical and virological characteristics of recurrent genital herpes simplex virus infection in healthy adults, recognition of the critical importance of early initiation of therapy, which is best achieved by self-initiated therapy, and an appreciation of the excellent tolerance and safety of relatively high doses of available antiviral drugs have facilitated refinements to treatment regimens that are more convenient as well as efficacious and well-tolerated. This paper reviews the progressive convergence of these concepts to an efficacious, well-tolerated, 1-day, patient-initiated regimen for treating episodes of recurrent genital herpes.
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During this time period, clarithromycin was on formulary, later delisted, and then relisted again. Valaciclovir and famciclovir were also added to the formulary. During the time clarithromycin was off the formulary, the rate of change in its monthly consumption was 0.0061 DDD/1000 population/day; following its relisting, the rate of change increased by 818% to 0.0560 DDD/1000 population/day (P=0.002). After the listing of valaciclovir on the formulary, the rate of change in its monthly consumption increased 57% from a baseline of 0.0014 to 0.0022 DDD/1000 population/day (P=0.07). A similar effect was seen with the addition of famciclovir to the formulary whereby the rate of change in monthly consumption increased from 0.0008 (before addition to the formulary) to 0.0018 (after addition to the formulary) (P = 0.001).
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419 immunocompetent adults with uncomplicated herpes zoster.
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This case represents a middle-aged female with breast carcinoma. Cancer radiotherapy and chemotherapy created an immunosuppressed state, which allowed the development of herpes zoster ophthalmicus. Most patients who manifest zoster are immunocompetent. However, with the increased incidence of immunodeficient states (e.g., chemotherapy, organ transplantation and acquired immunodeficiency syndrome), clinicians are faced with a greater number of cases of zoster. In the immunodeficient population, especially, dissemination of the zoster and potentially damaging complications can occur.
Penciclovir pharmacokinetics following oral famciclovir administration in cats appeared complex within the dosage range studied. Famciclovir dosages of 15 mg/kg administered every 8 hours to cats are unlikely to result in plasma penciclovir concentrations with activity against feline herpesvirus-1.
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Ninety-nine consecutive patients undergoing full-face laser or perioral resurfacing received either 500-mg or 250-mg famciclovir twice daily, beginning 24 hours prior to laser resurfacing and continuing for 10 days.
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Monitoring for the accumulation of unique mutations within the genome of drug resistant HBV mutants isolated during long term antiviral therapy appears warranted in the clinical management of patients with CHB.
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Hepatitis B virus genome mutants may be selected during the immune-mediated clearance of infection or during long-term nucleoside analog administration and may escape both antiviral pressures. The pattern of anti-HBe seroconversion was analyzed in patients receiving new nucleoside analogs, lamivudine or famciclovir, in comparison with patients treated with interferon alpha.
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The elimination of hepatitis B virus surface antigen (HBsAg) is the final goal of hepatitis B treatment, but is rarely achieved. As quantitative assays for HBsAg recently became available, we have investigated whether quantitative HBsAg measurements can substitute for hepatitis B virus (HBV) DNA quantification in treatment monitoring.