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Overview
of Therapy for Herpes Labialis (HSV-1), Genital Herpes (HSV-2) and
Herpes Zoster (HZV)
Acyclovir
(Zovirax) was approved for the treatment of herpesvirus infections
almost two decades ago. It was the first agent in a novel group
of antiviral medications that now include valacyclovir (Valtrex),
penciclovir (Denavir) and famciclovir (Famvir).
These
agents have made a dramatic impact on the morbidity associated with
herpes simplex virus infections and herpes zoster (varicella-zoster
virus). Topical and oral antiviral use have shown modest but statistically
significant efficacy in treating herpes labialis (herpes simplex
type 1) with most studies demonstrating a significant reduction
in episode length and/or healing time.
Oral
acyclovir, valacyclovir and famciclovir are efficacious and safe
for the treatment of the first episode and recurrent genital herpes
(herpes simplex type 2) and are useful as suppressive therapy for
individuals with frequent genital herpes recurrences.
In
addition, high doses of oral acyclovir, valacyclovir and famciclovir
have been shown to speed the healing of herpes zoster, and data
suggests that these agents also decrease associated acute and chronic
pain in people of 50 years of age or older.
Further
research is required to clarify the safety of these agents in pregnant
women with genital herpes, the role of antiviral therapy in decreasing
the sexual transmission of genital herpes, and the efficacy and
cost-effectiveness of these agents in treating herpes zoster in
people below the age of 50 years.
Key issues
•
Acyclovir was approved for the treatment of herpesvirus infections
almost two decades ago. It was the first agent in a novel group
of antiviral medications that now include valacyclovir, penciclovir
and famciclovir.
•
Use of topical and oral antiviral therapy has demonstrated modest
but statistically significant efficacy in the treatment of herpes
labialis. Most studies suggest a median reduction in episode length
and/or healing time of 0.5–1.6 days.
•
Oral acyclovir, valacyclovir and famciclovir are efficacious and
safe for treatment of first episode and recurrent genital herpes
and are useful as suppressive therapy for individuals with frequent
recurrences.
•
High-dose oral acyclovir, valacyclovir and famciclovir are efficacious
for treatment of herpes zoster in people 50 years of age or older.
These medications have been shown to speed healing and most data
suggest that they also decrease acute and chronic pain.
08/01/03
Reference
MD
Moomaw, P Cornea, RC Rathbun & KA Wendel.Expert Review of Anti-infective Therapy
1(2): 283–295. 2003.
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