ANTIVIRAL DRUG

							FRED Y AOKI, MD

OBJECTIVES
 Appreciate the brief time to peak virus titres

in recurrent herpes labialis & genitalis lesions and the correspondingly brief window of opportunity to start therapy.  Be reminded of 3 available antiviral drugs.  Appreciate evolution of antiviral drug regimens for therapy.  Be aware of most recent single day treatments

VIRUS CONCENTRATION IN RECURRENT COLD SORES PEAK AT 12 -24 HR. AFTER ONSET

Spruance, NEJM 237:69, 1997

Window of Opportunity to Treat with Antiviral Drug Therapy is Short (< 24 H)

VIRUS CONCENTRATION IN RECURRENT GENITAL HERPES LESIONS PEAK AT DAY 3 IN WOMEN & DAY 1 IN MEN

Brown West J Med 130:414, 1979

Window of Opportunity to Treat with Antiviral Drugs is Short (1 – 3 days)

ANTIVIRAL DRUGS EFFICACIOUS FOR THE TREATMENT OF RECURRENT HERPES LABIALIS & GENITALIS IN RANDOMIZED CONTROLLED TRIALS

I. For Recurrent Herpes labialis
A. Episode Therapy




Topical
Penciclovir - Q2h x 4 days Docosanol - 5 times per day ‘till healed





Oral Agents Valacyclovir - twice in 1 day Famciclovir – one dose

I.B.


Suppressive Therapy

Acyclovir  Valacyclovir
C.
 

Prophylactic Before Known Trigger
Acyclovir before trigeminal nerve surgery Acyclovir before sun exposure

II. For Recurrent Herpes genitalis
A. Episode Therapy

Acyclovir for 5 days  Valacyclovir for 3 days  Acyclovir for 2 days  Famciclovir single day


B.


Suppressive Therapy
All 3 drugs efficacious

SINGLE DAY TREATMENTS FOR EPISODES OF RECURRENT HERPES LABIALIS
A. For Recurrent Herpes labialis



Valacyclovir 2 g twice in 1 day Famciclovir 1.5 g once or 750 mg twice
Famciclovir 1 g twice

B. For Recurrent Genital herpes


FAMCICLOVIR 1 G TWICE IN 1 DAY COMPARED TO PLACEBO STARTED AT < 6 HR. AFTER ONSET
A. Doubled aborted lesions from 13% to 23%

B. Shortened mean healing time by 2 days from 6.1 & 4.3 days

C. Caused more headache (14% vs 5%)
Aoki, JCID 42:8, 2006

TO MAKE SINGLE-DAY THERAPY OF RECURRENT HERPES LABIALIS & GENITALIS EFFECTIVE

 Provide prescription to be filled.
 Tell patient to carry first dose on

person at all times.  Educate patient to enable initiation of therapy at < 6 h.