1. A randomized, double-blind trial of valaciclovir prophylaxis for cytomegalovirus disease in patients with advanced human immunodeficiency virus infection. AIDS Clinical Trials Group Protocol 204/Glaxo Wellcome 123-014 International CMV Prophylaxis Study Group.
- Author
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Feinberg JE, Hurwitz S, Cooper D, Sattler FR, MacGregor RR, Powderly W, Holland GN, Griffiths PD, Pollard RB, Youle M, Gill MJ, Holland FJ, Power ME, Owens S, Coakley D, Fry J, and Jacobson MA
- Subjects
- AIDS-Related Opportunistic Infections prevention & control, AIDS-Related Opportunistic Infections virology, Acyclovir administration & dosage, Acyclovir adverse effects, Administration, Oral, Adult, Antiviral Agents administration & dosage, Antiviral Agents adverse effects, CD4 Lymphocyte Count, Cytomegalovirus Infections diagnosis, Cytomegalovirus Infections prevention & control, Double-Blind Method, Female, Humans, Male, Valacyclovir, Valine administration & dosage, Valine adverse effects, Valine therapeutic use, AIDS-Related Opportunistic Infections drug therapy, Acyclovir analogs & derivatives, Acyclovir therapeutic use, Antiviral Agents therapeutic use, Cytomegalovirus Infections drug therapy, Valine analogs & derivatives
- Abstract
Cytomegalovirus (CMV) disease is a common complication of advanced human immunodeficiency virus (HIV) infection. Administration of oral valaciclovir, a valine ester of acyclovir, achieves sufficient plasma acyclovir levels to inhibit many clinical isolates. Acyclovir has been associated with enhanced survival in AIDS but not with CMV disease prevention. CMV-seropositive patients (1227) with CD4 cell counts <100/mm3 were enrolled in a randomized, double-blind trial. Valaciclovir, 8 g/day, was compared with acyclovir, 3.2 or 0.8 g/day, for CMV prevention; all three arms were compared for survival. The confirmed CMV disease rate was 11.7% among valaciclovir recipients and 17.5% in the pooled acyclovir arms, a 33% reduction in risk. Time to confirmed CMV disease was significantly longer for the valaciclovir group (P = .03). A trend toward earlier mortality for valaciclovir recipients was seen (P = .06). Toxicity and earlier medication discontinuation were more common in this group. Valaciclovir significantly reduces the risk of CMV disease. Further exploration of a better-tolerated dose is warranted.
- Published
- 1998
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