ACYCLOVIR FOR THE PREVENTION OF RECURRENT HERPES-SIMPLEX VIRUS EYE DISEASE

Background Long-term treatment with antiviral agents has been shown to prevent recurrences of genital and orofacial herpes simplex virus (HS V) disease, but it is uncertain whether prophylactic treatment can pre vent recurrences of ocular HSV disease. Methods We randomly assigned 7 03 immunocompetent patients who had had ocular HSV disease within the preceding year to receive 400 mg of acyclovir or placebo orally twice daily. The study outcomes were the rates of development of ocular or n onocular HSV disease during a 12-month treatment period and a B-month observation period. Results The cumulative probability of a recurrence of any type of ocular HSV disease during the 12-month treatment perio d was 19 percent in the acyclovir group and 32 percent in the placebo group (P<0.001). Among the 337 patients with a history of stromal kera titis, the most common serious form of ocular HSV disease, the cumulat ive probability of recurrent stromal keratitis was 14 percent in the a cyclovir group and 28 percent in the placebo group (P=0.005). The cumu lative probability of a recurrence of nonocular (primarily orofacial) HSV disease was also lower in the acyclovir group than in the placebo group (19 percent vs. 36 percent, P<0.001), There was no rebound in th e rate of HSV disease in the six months after treatment with acyclovir was stopped. Conclusions After the resolution of ocular HSV disease, 12 months of treatment with acyclovir reduces the rate of recurrent oc ular HSV disease and orofacial HSV disease. Long-term antiviral prophy laxis is most important for patients with a history of HSV stromal ker atitis, since it can prevent additional episodes and potential loss of vision. (N Engl J Med 1998;339:300-6.) (C)1998, Massachusetts Medical Society.