Being Alive; March 1994
Mark Katz, MD and reported by Jim Stoecker

CMV is one of the opportunistic infections for which we have not developed an effective prophylaxis. Since CMV is a cousin to the herpes virus, some researchers believed that acyclovir might be useful in controlling CMV.

About two years ago, there was a study of people with AIDS who had less than 150 T-cells. Researchers treated the subjects with high dose acyclovir (800 mg four times a day) to see if there was a decreased incidence of CMV among those treated. They found that there was no difference in development of CMV between those taking acyclovir and those not taking the drug. However, researchers did find that median survival time for those on acyclovir was longer than for those not being treated.

Does acyclovir increase survival time for people with AIDS? Researchers speculated that acyclovir might be synergistic with AZT, causing the antiviral to be more effective. Or, it could be that acyclovir holds the herpes virus in check which otherwise would cause HIV to replicate more quickly. Despite this study, use of acyclovir has not become the standard of care for treating late-stage HIV disease.

Now we have a new study of acyclovir and HIV. Dr. Daniel Stein of the National Institute of Allergies and Infectious Diseases recently reported on a study of 786 MACS participants. All subjects took AZT prior to the development of AIDS. In addition, 515 of this group also took acyclovir. Acyclovir was used because the individual had a history of herpes or because of the drug's alleged anti-HIV effects. The median dose was 600-800 mg per day.

Stein reported that for those who began taking acyclovir before an AIDS diagnosis, there was statistically significant improved survival if they did so for anti-HIV reasons, but not if taking acyclovir for anti-herpes reasons. For those beginning acyclovir after a diagnosis of AIDS, there was statistically significant increased survival for all.

This study adds more evidence that acyclovir may be useful in fighting HIV. In fact, Stein concluded that there is now a substantial body of data to suggest that acyclovir, when used in combination with AZT, has clinical benefits for people with AIDS.

Of course, Stein's study was not a randomized trial, with a control group. Such studies are needed before we revise the current standard of care. Nonetheless, acyclovir, in combination with an antiviral, may be an option to consider, if one is able to cover the high cost of this drug.

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