Famciclovir reduces viral mucosal shedding in HSV-seropositive persons

Peter Leone, Terri Warren, Kamal Hamed, Kenneth Fife, Anna Wald

Research output: Contribution to journalArticle

22 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)900-907
Number of pages8
JournalSexually Transmitted Diseases
Volume34
Issue number11
DOIs
StatePublished - Nov 2007

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Virus Shedding
Herpes Genitalis
Simplexvirus
Human Herpesvirus 2
Virus Diseases
Herpetic Stomatitis
History
Placebos
famciclovir
Human Herpesvirus 1
Antiviral Agents
Therapeutics
Multivariate Analysis
Polymerase Chain Reaction
DNA

ASJC Scopus subject areas

  • Dermatology
  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)

Cite this

Famciclovir reduces viral mucosal shedding in HSV-seropositive persons. / Leone, Peter; Warren, Terri; Hamed, Kamal; Fife, Kenneth; Wald, Anna.

In: Sexually Transmitted Diseases, Vol. 34, No. 11, 11.2007, p. 900-907.

Research output: Contribution to journalArticle

Leone, Peter ; Warren, Terri ; Hamed, Kamal ; Fife, Kenneth ; Wald, Anna. / Famciclovir reduces viral mucosal shedding in HSV-seropositive persons. In: Sexually Transmitted Diseases. 2007 ; Vol. 34, No. 11. pp. 900-907.
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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.",
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