Famciclovir reduces viral mucosal shedding in HSV-seropositive persons.

Abstract

OBJECTIVE:

Many cases of herpes simplex virus (HSV) infection occur through asymptomatic shedding from persons without evidence of clinical disease. This study explores whether famciclovir reduces HSV shedding in HSV-2 seropositive persons with or without a history of symptomatic genital herpes.

STUDY DESIGN:

One hundred twenty-seven HSV-2 seropositive participants were randomly assigned to 42 days of famciclovir, followed by 14 days of washout and 42 days of placebo, or vice versa. All subjects swabbed the genital/perianal area; those with HSV-1 infection also swabbed the oral area daily for HSV DNA PCR.

RESULTS:

Famciclovir reduced genital and oral HSV shedding from 11.4% of days during the placebo period to 4.7% of days during famciclovir therapy. The reduction was greater in participants with a history of genital herpes (74%) than in those without such a history (30%). In multivariate analyses, famciclovir protected against total (clinical and subclinical) genital shedding among persons with a clinical history of genital herpes (RR, 0.23; 95% CI, 0.15-0.35; P < 0.001). Among HSV-2 seropositive participants without a history of genital herpes, 60% had HSV detected in the genital area at least once during the study. Famciclovir therapy did not result in a statistically significant reduction in total HSV shedding in participants without a history of genital herpes.

CONCLUSION:

Famciclovir therapy decreases genital HSV shedding in HSV-seropositive persons, especially those with a history of genital herpes. Overall, antiviral drugs may have varying effects on symptomatic and asymptomatic viral shedding, depending on the clinical history of the disease.

• Authors: Peter Leone, Terri Warren, Kamal Hamed, Kenneth Fife, Anna Wald
• Journal: Sexually transmitted diseases (Sex Transm Dis) Vol. 34 Issue 11 Pg. 900-7 (Nov 2007) ISSN: 0148-5717 [Print] United States
• PMID: 17538513 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antiviral Agents
• DNA, Viral
• 2-Aminopurine
• Famciclovir

Topics

• 2-Aminopurine (administration & dosage, analogs & derivatives, pharmacology, therapeutic use)
• Adolescent
• Adult
• Aged
• Antiviral Agents (administration & dosage, pharmacology, therapeutic use)
• Cross-Over Studies
• DNA, Viral (analysis)
• Double-Blind Method
• Famciclovir
• Female
• Herpes Genitalis (blood, drug therapy, virology)
• Herpesvirus 2, Human
• Humans
• Male
• Middle Aged
• Mucous Membrane (virology)
• Polymerase Chain Reaction
• Treatment Outcome
• Virus Shedding (drug effects)
• Washington