Treatment Review #17 - March 1995

The drug acyclovir, approved by the federal government for the treatment of herpesvirus infections, is a safe and effective drug. This drug has been used for well over a decade, and the reported side effects have been minor. Several years ago it was suggested that taking this drug may actually help people with AIDS to live longer. The reason for this suggestion is that pieces of the herpesvirus can interact with HIV and cause an increase in HIV levels. One recent study showed that when a herpesvirus is active, the level of HIV in the body escalates. Although herpesviruses may not be as lethal as the HIV virus - still, hundreds of people die every year from them - herpesviruses cause serious damage to the immune system and the body. Just because one virus is already causing damage does not mean that many more won't come along and join in.

The point here is that any virus that someone is infected with - HIV, herpesviruses, hepatitis - needs to be treated. Viruses rarely go away by themselves. There is a common belief that the herpesvirus lies dormant until something provokes an outbreak. This may be true, but it sounds similar to what we thought for many years about the HIV virus. We now know this is just not true. Over a billion HIV infected cells are produced everyday, regardless of the symptoms or infections that someone has. If herpesviruses do the same thing, while causing HIV to multiply, shouldn't researchers be testing everything they can think of to stop herpesviruses as well? Where's the fire? One needs to be started.

A recent finding that the cancer Kaposi's sarcoma (KS) may be caused by a herpesvirus - and possibly treatable with herpes drugs - adds some fuel. Also, the article on CMV - another herpesvirus - describes the positive results of the study of a herpesvirus drug, oral ganciclovir, used to prevent CMV disease in people with less than 100 T4 cells.

Still another study - ACTG 204 - recently announced that the two arms of a three arm study that were taking acyclovir did better than the other group that was taking valacyclovir, an acyclovir pro-drug. The idea behind a pro-drug is simple. Basically, the drug turns into the drug that it is a pro-drug of once in the body. When you give someone valacyclovir, it turns into acyclovir in the body. Is this what really happens, or is this just what we think happens? Did the drug valacyclovir work less well in this study than the drug acyclovir, or did acyclovir work very well? Or, as a recent epidemiological study suggests, is taking an anti-herpes drug on a regular basis more important than how much is taken? The idea behind valacyclovir is to get as much of the drug it turns into - acyclovir - into the body. Perhaps that's not what the body wants. None of these questions change the observation that taking a small dose of acyclovir - an already approved drug - may help keep people alive for a longer period of time, and help them to prevent KS.

We know that herpesvirus increase HIV levels. They may cause KS. Hemophiliacs who became HIV positive through contaminated blood - until a few years ago blood was not routinely screened for the HIV virus - die faster if they are also infected with a herpesvirus. Some people with HIV disease are already taking acyclovir. Its hard to believe that everyone with HIV disease isn't taking it. It's hard to believe that federal researchers and industry scientists aren't shouting from the rooftops that we may have stumbled on an important lead on how to treat one - or more - deadly viruses.

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