Infections post transplant Valacyclovir prophylaxis for the prevention of Herpes simplex virus reactivation in recipients of progenitor cells transplantation

Summary:HSV can cause oral lesions that exacerbate chemo-therapy-related mucositis. Intravenous acyclovir iseffective in preventing HSV reactivations, but expens-ive. Valacyclovir has good bioavailability and has notbeen studied for prophylaxis of HSV among PCTpatients. We compared the efficacy and costs of valacy-clovir in preventing HSV reactivation among HSV sero-positive autologous progenitor cell transplantation(APCT) patients with historical controls in whom intra-venous acyclovir or no HSV prophylaxis were used. Val-acyclovir group: From October 1997 to April 1999 108adult patients received valacyclovir 500 mg twice dailyfrom day − 3 of APCT until neutropenia recovery or day + 30. Valacyclovir was switched to intravenous acyclovirin cases of oral intolerance (17 patients) or suspectedHSV reactivation (five patients). Intravenous acyclovirgroup: From January 1996 to October 1997 43 patientsreceived 5 mg/kg twice-daily intravenous acyclovir fromday − 3 until recovery from neutropenia. No prophylaxisgroup: 38 patients from January 1996 to October 1997did not receive HSV prophylaxis. HSV reactivationswere seen in 2.7%, 2% and 45% of patients in the vala-cyclovir, intravenous acyclovir, and no prophylaxisgroups, respectively. Valacyclovir was well toleratedand was the least expensive strategy. Oral valacyclovirwas as effective as intravenous acyclovir for the prophy-laxis of HSV reactivation in APCT patients.