3rd Conference on Retroviruses and Opportunistic Infections Washington, DC - January 28-February 1, 1996

Conf Retroviruses Opportunistic Infect 1996 Jan 28-Feb 1; 3rd:55 (abstract no. 12)

Gnann J, Crumpacker C, Lalezari J, Smith J, Pollard R, Mertz G, Steigbigel R, Cloud G, Soong S, Laughlin C, et al
Univ. of AL, Birmingham, AL.

Sorivudine is a nucleoside antiviral drug with excellent in vitro activity against varicella-zoster virus. Using a double -blind/double-dummy study design, we compared the efficacy of sorivudine (40 mg po once daily x 10d) with acyclovir (800 mg PO 5 times daily x 10d) for treatment of dermatormal herpes zoster in 170 HIV-infected patients. All were enrolled within 72 hr of rash onset (median=2 days) and evaluated daily until lesions were completely crusted. Median patient age was 36 years and the median CD4 cell count was 169/cmm. The Cox proportional hazard model (adjusted for age, gender, baseline pain severity, percentage of vesicular and maculopapular lesions, duration of rash, CD4 count, stage of HIV disease, and prior acyclovir use) was utilized to evaluate the effect of treatment on study endpoints. The time to cessation of new vesicle formation was significantly shorter among sorivudine recipients than among acyclovir recipients (RR=1.45, 95% C1 1.04-5.00; P=0.027). Time to total crusting was also shorter for the sorivudine group (RR 1.47, 95% CI 1.06-2.03; P0.020). Interestingly, patients with CD4 less than 200 had shorter times to new vesicle cessation (RR= l.49, 95% CI 1.08-2.08; p=0.018) and to total crusting (RR=1.41, 95% CI 1.02-1.96; p=0.039) than patients with CD4 greater than 200. Time to resolution of acute pain was not different between the two treatment groups. Both drugs were well-tolerated and there were no significant differences in adverse events between the groups. In summary, sorivudine was superior to acyclovir in accelerating the events of cutaneous healing for HIV-infected patients with herpes zoster. Sorivudine has the additional advantage of a simplified once-a-day dosing regimen.

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