A virologic pilot study of valacyclovir in infectious mononucleosis

Henry H Balfour; Kristin M. Hokanson; Robyn M. Schacherer; Christine M. Fietzer; David O. Schmeling; Carol J. Holman; Heather E. Vezina; Richard Brundage

doi:10.1016/j.jcv.2007.02.002

A virologic pilot study of valacyclovir in infectious mononucleosis

Henry H Balfour, Kristin M. Hokanson, Robyn M. Schacherer, Christine M. Fietzer, David O. Schmeling, Carol J. Holman, Heather E. Vezina, Richard Brundage

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Abstract

Background: Infectious mononucleosis decreases the productivity of many college students and Epstein-Barr virus (EBV) infection may result in long-term immune damage. Objectives: Evaluate the antiviral effect of valacyclovir during EBV-related acute infectious mononucleosis and explore potential clinical benefits. Study design: University students who presented during the first 7 days of illness were randomized to receive valacyclovir 3 g/day for 14 days or not. The quantity of Epstein-Barr virus (EBV) DNA in oral and whole blood samples was determined by real-time (TaqMan) PCR. The primary outcome was the proportion of subjects with laboratory-confirmed primary EBV infection who had ≥2 log₁₀ decrease in EBV copies/mL in oral washes during the treatment period. Secondary outcomes included clinical effects. Results: Twenty subjects were studied. The proportion of valacyclovir recipients versus control subjects who had ≥2 log₁₀ decrease in EBV copies was significantly greater for both oral wash fluid-derived cell pellet (P = 0.03) and supernatant (P = 0.001) samples. At the end of the treatment period, the number of reported symptoms (P = 0.03) and the severity of illness (P = 0.049) were reduced among valacyclovir recipients as compared with controls. Conclusions: Valacyclovir therapy caused a reduction of EBV excretion and possibly produced a clinical benefit in infectious mononucleosis. Because our study was small and not placebo-controlled, these results must be confirmed by a larger, placebo-controlled trial.

Original language	English (US)
Pages (from-to)	16-21
Number of pages	6
Journal	Journal of Clinical Virology
Volume	39
Issue number	1
DOIs	https://doi.org/10.1016/j.jcv.2007.02.002
State	Published - May 2007

Bibliographical note

Funding Information:
We are indebted to the University of Minnesota students who participated in the clinical trial, the staff of the Boynton Health Service who referred them, and the personnel of the Clinical Virology Laboratory of the University of Minnesota, Fairview for the performance of the EBV antibody tests. This study was approved by the University of Minnesota Institutional Review Board and the Boynton Health Service Research Committee. Informed consent was obtained from each subject prior to enrollment. It was presented in part at the 45th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, DC, December 18, 2005 (abstract V1392). The research was supported by grants from the Minnesota Medical Foundation, the University of Minnesota International Center for Antiviral Research and Epidemiology (I CARE), and an investigator-initiated grant from Roche Laboratories. All authors state that they have no conflicts of interest that could inappropriately influence this work.

Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.

Keywords

EBV viremia
Epstein-Barr virus
Infectious mononucleosis
Real-time EBV PCR
Valacyclovir

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title = "A virologic pilot study of valacyclovir in infectious mononucleosis",

abstract = "Background: Infectious mononucleosis decreases the productivity of many college students and Epstein-Barr virus (EBV) infection may result in long-term immune damage. Objectives: Evaluate the antiviral effect of valacyclovir during EBV-related acute infectious mononucleosis and explore potential clinical benefits. Study design: University students who presented during the first 7 days of illness were randomized to receive valacyclovir 3 g/day for 14 days or not. The quantity of Epstein-Barr virus (EBV) DNA in oral and whole blood samples was determined by real-time (TaqMan) PCR. The primary outcome was the proportion of subjects with laboratory-confirmed primary EBV infection who had ≥2 log10 decrease in EBV copies/mL in oral washes during the treatment period. Secondary outcomes included clinical effects. Results: Twenty subjects were studied. The proportion of valacyclovir recipients versus control subjects who had ≥2 log10 decrease in EBV copies was significantly greater for both oral wash fluid-derived cell pellet (P = 0.03) and supernatant (P = 0.001) samples. At the end of the treatment period, the number of reported symptoms (P = 0.03) and the severity of illness (P = 0.049) were reduced among valacyclovir recipients as compared with controls. Conclusions: Valacyclovir therapy caused a reduction of EBV excretion and possibly produced a clinical benefit in infectious mononucleosis. Because our study was small and not placebo-controlled, these results must be confirmed by a larger, placebo-controlled trial.",

keywords = "EBV viremia, Epstein-Barr virus, Infectious mononucleosis, Real-time EBV PCR, Valacyclovir",

author = "Balfour, {Henry H} and Hokanson, {Kristin M.} and Schacherer, {Robyn M.} and Fietzer, {Christine M.} and Schmeling, {David O.} and Holman, {Carol J.} and Vezina, {Heather E.} and Richard Brundage",

note = "Funding Information: We are indebted to the University of Minnesota students who participated in the clinical trial, the staff of the Boynton Health Service who referred them, and the personnel of the Clinical Virology Laboratory of the University of Minnesota, Fairview for the performance of the EBV antibody tests. This study was approved by the University of Minnesota Institutional Review Board and the Boynton Health Service Research Committee. Informed consent was obtained from each subject prior to enrollment. It was presented in part at the 45th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, DC, December 18, 2005 (abstract V1392). The research was supported by grants from the Minnesota Medical Foundation, the University of Minnesota International Center for Antiviral Research and Epidemiology (I CARE), and an investigator-initiated grant from Roche Laboratories. All authors state that they have no conflicts of interest that could inappropriately influence this work. Copyright: Copyright 2008 Elsevier B.V., All rights reserved.",

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AU - Fietzer, Christine M.

AU - Schmeling, David O.

AU - Holman, Carol J.

AU - Vezina, Heather E.

AU - Brundage, Richard

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N2 - Background: Infectious mononucleosis decreases the productivity of many college students and Epstein-Barr virus (EBV) infection may result in long-term immune damage. Objectives: Evaluate the antiviral effect of valacyclovir during EBV-related acute infectious mononucleosis and explore potential clinical benefits. Study design: University students who presented during the first 7 days of illness were randomized to receive valacyclovir 3 g/day for 14 days or not. The quantity of Epstein-Barr virus (EBV) DNA in oral and whole blood samples was determined by real-time (TaqMan) PCR. The primary outcome was the proportion of subjects with laboratory-confirmed primary EBV infection who had ≥2 log10 decrease in EBV copies/mL in oral washes during the treatment period. Secondary outcomes included clinical effects. Results: Twenty subjects were studied. The proportion of valacyclovir recipients versus control subjects who had ≥2 log10 decrease in EBV copies was significantly greater for both oral wash fluid-derived cell pellet (P = 0.03) and supernatant (P = 0.001) samples. At the end of the treatment period, the number of reported symptoms (P = 0.03) and the severity of illness (P = 0.049) were reduced among valacyclovir recipients as compared with controls. Conclusions: Valacyclovir therapy caused a reduction of EBV excretion and possibly produced a clinical benefit in infectious mononucleosis. Because our study was small and not placebo-controlled, these results must be confirmed by a larger, placebo-controlled trial.

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A virologic pilot study of valacyclovir in infectious mononucleosis

Abstract

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Keywords

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