Hann I M, Prentice H G, Blacklock H A, Ross M G, Brigden D, Rosling A E, Burke C, Crawford D H, Brumfitt W, Hoffbrand A V
Br Med J (Clin Res Ed). 1983 Aug 6;287(6389):384-8. doi: 10.1136/bmj.287.6389.384.
Twenty patients undergoing allogeneic bone marrow transplantation and 39 patients receiving remission induction chemotherapy for acute leukaemia were entered into a double blind, placebo controlled stratified trial of acyclovir prophylaxis against herpes group virus infections. Within the transplant group intravenous acyclovir 5 mg/kg twice daily given throughout the period of granulocytopenia completely prevented oropharyngeal herpes simplex virus infection compared with a 50% incidence in the placebo arm (p = 0.033). The acyclovir group also had fewer days of fever during the trial and a shorter duration of leukopenia, possibly because of the prevention of herpes simplex virus infections. There was a high incidence of herpes infections after the trial in patients who received either acyclovir or placebo. In the non-transplant group there was also a significant reduction of herpes simplex virus infection in the oropharynx and oesophagus (two out of 19 patients as compared with 10 out of 20; p = 0.018). Herpes simplex virus was isolated in the acyclovir arm within a day after starting the trial in one patient, and the other failure was due to a virus with reduced sensitivity to acyclovir in a patient who had had several previous courses of the drug. The incidence of herpes infections after stopping treatment was low. The influence of acyclovir on excretion of Epstein-Barr virus in saliva in either group was inconclusive. One patient (transplant group) developed a cytomegalovirus infection while receiving acyclovir. Acyclovir provides effective prophylaxis against oropharyngeal and oesophageal herpes simplex virus infection in severely immunocompromised seropositive (greater than or equal to 1/8) patients. In patients given bone marrow transplants this may have the additional benefit of reducing the time to recovery of an adequate blood count and the number of days of fever.
20例接受异基因骨髓移植的患者和39例接受急性白血病缓解诱导化疗的患者进入了一项阿昔洛韦预防疱疹病毒感染的双盲、安慰剂对照分层试验。在移植组中，在粒细胞减少期全程给予静脉注射阿昔洛韦5mg/kg，每日2次，完全预防了口咽单纯疱疹病毒感染，而安慰剂组的感染发生率为50%（p = 0.033）。阿昔洛韦组在试验期间发热天数也较少，白细胞减少持续时间较短，这可能是由于预防了单纯疱疹病毒感染。试验后，接受阿昔洛韦或安慰剂的患者疱疹感染发生率较高。在非移植组中，口咽和食管单纯疱疹病毒感染也显著减少（19例患者中有2例，而20例患者中有10例；p = 0.018）。在试验开始后一天内，阿昔洛韦组有1例患者分离出单纯疱疹病毒，另一例治疗失败是由于一名此前曾多次使用该药物的患者体内的病毒对阿昔洛韦敏感性降低。停药后疱疹感染发生率较低。阿昔洛韦对两组患者唾液中EB病毒排泄的影响尚无定论。1例患者（移植组）在接受阿昔洛韦治疗时发生了巨细胞病毒感染。阿昔洛韦能有效预防严重免疫功能低下的血清阳性（大于或等于1/8）患者的口咽和食管单纯疱疹病毒感染。对于接受骨髓移植的患者，这可能还有额外的益处，即减少恢复足够血细胞计数的时间和发热天数。
