The Role of Acyclovir in the Treatment of Herpes zoster Virus Infections in Immunocompromised Children

Abstract

Objective: Varicella and herpes zoster are infectious diseases caused by varicella-zoster virus (VZV) and are generally not serious diseases in immunocompetent patients. However, patients with impaired cellular immunity because of chemotherapy, immune suppressive agent, HIV infection, and primary immune deficiency syndromes have tendency toward causing infections with VZV; also, VZV infections may be more severe with complications in these patient groups. Acyclovir is the drug of choice for treatment of both illnesses. Herein, we aim to describe the characteristics of VZV infections and the role of acyclovir in the treatment of immunocompromised children for these infections. Materials and Methods: Thirty-three children with primary or secondary immune deficiency syndromes aged less than 18 years who were admitted to the Pediatrics clinic of Marmara University Medical Faculty Hospital for varicella or herpes zoster infections between January 2012 and June 2015 were enrolled in this study. Data about clinical manifestations, treatment, and prognosis of VZV infections are collected by performing a chart review of these patients. Results: Thirty-three patients enrolled into the study were aged between 6 months and 16 years with the mean age of 96 +/- 52 months. The reasons for causing immune suppression were solid tumor in 15 patients, ALL in 7, primary immune deficiency in 5, immune suppressive drug usage in 3, HIV in 1, organ transplantation in 2 patients. Seven patients were treated for herpes zoster and 16 for varicella. Acyclovir was administered with a dosage of 1500 mg/m(2)/day divided in three intravenous doses in the first 72 hours of disease manifestations, and the mean duration of treatment was 7 days (range 3-11). Vesicular rash begun to be crusted at 3. Day of treatment and completely crusted at 5th day in all patients. No complications of infection or drug-related adverse effects were observed. Conclusion: This study showed that acyclovir is still safe and is an effective agent for VZV infections; particularly, to prevent complications and dissemination of infection in immunocompromised children, acyclovir administration should be initiated immediately.