Clinical Characteristics of Herpes Zoster in Immunocompromised Patients and Analysis of Pharmacokinetics of Acyclovir

Lee, Dong Gun; Kim, Woon Hak; Huh, Dong Ho; Choi, Jung Hyun; Shin, Wan Shik; Kim, Ok Nyu; Min, Chang Ki; Kim, Dong Wook; Lee, Jong Wook; Min, Woo Sung; Kim, Chun Choo

Abstract

BACKGROUND
We investigated this study to elucidate the clinical characteristics of herpes zoster in immunocompromised patients and to analyze the pharmacokinetics of acyclovir with the response of therapy.
METHODS
A total of 51 immunocompromised patients with herpes zoster were studied prospectively over 22 months (Dec. 1997-Sep. 1999). Patients were randomized to 4 groups according to pharmaceutical company (company A or B) and method of infusion (intermittently or continuously) of acyclovir. Patients were assigned to receive acyclovir (10 mg/kg, three times daily) intermittently, or acyclovir (5 mg/kg bolus, and then 40 mg/kg/day) continuously for 7 days respectively.
RESULTS
Mean age was 31.9+/-12.6 years and the ratio of male to female was 1:1.68. Dermatome involvement was most frequently on the thoracic dermatome (49%), followed by cervical, lumbar dermatome. Forty-two (82.3%) patients received hematopoietic stem cell transplantation and herpes zoster was most prevalent in average 9.2+/-7.9 months after transplantation. Thirty (58%) patients had been taken immunosuppressants at the onset of herpes zoster. Recurrence rate of herpes zoster was 7.8%. Overall adverse experience rate was 15.7%. Pharmacokinetic parameter of acyclovir from company B was close to reference as compared with those of company A. There was no difference in steady-state concentration (Css) of acyclovir between intermittent and continuous infusion. Cessation of new lesion formation occurred 4.1+/-1.3 days after initiation of therapy without statistically significant intergroup differences. Rate to loss of vesicle over 50% at the seventh day of infusion also showed no intergroup differences, but tended to highest at the continuous group of company B.
CONCLUSION
Herpes zoster in immunocompromised patients were prevalent during the use of immunosuppressant, mostly within 1 year after hematopoietic stem cell transplantation. Anatomical distribution was just like that of immunocompetent patients, but recurred more frequently. Clinical response was not different according to the pharmaceutical company or method of infusion. Supplementary evaluation to the dose of acyclovir, method of infusion, duration of treatment, and alternatives may be required.