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Hwang-Bo J, Kim B, Park DW, Lee YG, Kwon JE, Chung JY, Kang SC. Safety, tolerability of ES16001, a novel varicella zoster virus reactivation inhibitor, in healthy adults. Eur J Med Res 2021; 26:92. [PMID: 34384499 PMCID: PMC8359576 DOI: 10.1186/s40001-021-00565-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/03/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose Herpes zoster (HZ), or shingles, is a clinical syndrome resulting from the reactivation of latent varicella zoster virus (VZV) within the sensory ganglia. We evaluated the safety and tolerability of ES16001 (ethanol extract of Elaeocarpus sylvestris var. ellipticus), a novel inhibitor of varicella zoster virus reactivation in healthy adults. Method Single-center, randomized, double-blind, placebo-controlled, single and multiple ascending dose (SAD and MAD, respectively) studies were conducted in 20- to 45-year-old healthy adults without chronic disease. In the SAD study (n = 32), subjects randomly received a single oral dose of 240, 480, 960, or 1440 mg ES16001 or a placebo. In the MAD study (n = 16), subjects randomly received once daily doses of 480 or 960 mg ES16001 or a placebo for 5 days. The safety and tolerability of the drug were evaluated by monitoring participants’ treatment emergent adverse events (TEAEs) and vital signs, electrocardiograms (ECGs), physical examinations, and clinical laboratory tests. Results In the SAD study, 11 adverse reactions were seen in 5 subjects, and in the MAD study, 8 adverse reactions were seen in 6 subjects. All adverse reactions were mild, and no serious adverse reactions occurred. The most common adverse reaction was an increase in alanine aminotransferase (ALT), but all test values were in the clinically non-significant range, and their clinical significance was judged to be small considering the fact that most of the test values returned to normal immediately after the end of drug administration. Conclusion ES16001 has good safety and tolerability when administered both once and repeatedly to healthy subjects. Further research is needed to identify any possible drug-induced hepatotoxicity, which appears infrequently. Our findings provide a rationale for further clinical investigations of ES16001 for the prevention of HZ. Trial registration: CRIS, KCT0006066. Registered 7 April 2021—Retrospectively registered, https://cris.nih.go.kr/cris/search/detailSearch.do/19071). Supplementary Information The online version contains supplementary material available at 10.1186/s40001-021-00565-z.
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Affiliation(s)
- Jeon Hwang-Bo
- Graduate School of Biotechnology and Department of Oriental Medicine Biotechnology, Kyung Hee University, Yongin, 17104, Republic of Korea
| | - Byungwook Kim
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Dae Won Park
- Graduate School of Biotechnology and Department of Oriental Medicine Biotechnology, Kyung Hee University, Yongin, 17104, Republic of Korea
| | - Yeong-Geun Lee
- Graduate School of Biotechnology and Department of Oriental Medicine Biotechnology, Kyung Hee University, Yongin, 17104, Republic of Korea
| | - Jeong Eun Kwon
- Graduate School of Biotechnology and Department of Oriental Medicine Biotechnology, Kyung Hee University, Yongin, 17104, Republic of Korea
| | - Jae-Yong Chung
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Bundang Hospital, Seongnam, Republic of Korea.
| | - Se Chan Kang
- Graduate School of Biotechnology and Department of Oriental Medicine Biotechnology, Kyung Hee University, Yongin, 17104, Republic of Korea.
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Dolskiy AA, Grishchenko IV, Yudkin DV. Cell Cultures for Virology: Usability, Advantages, and Prospects. Int J Mol Sci 2020; 21:ijms21217978. [PMID: 33121109 PMCID: PMC7662242 DOI: 10.3390/ijms21217978] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 12/14/2022] Open
Abstract
Virus detection in natural and clinical samples is a complicated problem in research and diagnostics. There are different approaches for virus isolation and identification, including PCR, CRISPR/Cas technology, NGS, immunoassays, and cell-based assays. Following the development of genetic engineering methods, approaches that utilize cell cultures have become useful and informative. Molecular biology methods allow increases in the sensitivity and specificity of cell cultures for certain viruses and can be used to generate reporter cell lines. These cell lines express specific reporter proteins (e.g., GFP, luciferase, and CAT) in response to virus infection that can be detected in a laboratory setting. The development of genome editing and synthetic biology methods has given rise to new perspectives regarding the design of virus reporter systems in cell cultures. This review is aimed at describing both virology methods in general and examples of the development of cell-based methods that exist today.
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Collet A, Baes D, Mambie A, Hembert K, Boulle C, Gana I, Lemaire X. VZV meningoencephalitis treated with ganciclovir. Med Mal Infect 2020; 50:444-445. [DOI: 10.1016/j.medmal.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/09/2019] [Accepted: 03/02/2020] [Indexed: 11/26/2022]
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Huang Y, Liu H, Sun X, Ding M, Tao G, Li X. Honeysuckle-derived microRNA2911 directly inhibits varicella-zoster virus replication by targeting IE62 gene. J Neurovirol 2019; 25:457-463. [PMID: 31140131 DOI: 10.1007/s13365-019-00741-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/17/2019] [Accepted: 02/26/2019] [Indexed: 12/16/2022]
Abstract
Varicella-zoster virus (VZV) leads to chicken pox on primary infection and herpes zoster on reactivation. Recent studies suggest that microRNA2911 (MIR2911), honeysuckle (HS)-encoded atypical microRNA, has potential as a therapeutic agent against influenza and EV71 virus infections. Here, we report that MIR2911 directly inhibits VZV replication by targeting the IE62 gene. The luciferase reporter assay and bioinformatics prediction revealed that MIR2911 could target the IE62 gene of VZV. The VZV-encoded IE62 protein expression was inhibited significantly by synthetic MIR2911, while the expression of the mutants, whose MIR2911-binding sites were modified, was not inhibited. The RNA extracted from HS decoction and synthetic MIR2911 considerably suppressed VZV infection. However, it did not influence viral replication of a mutant virus with alterations in the nucleotide sequences of IE62. At the same time, the RNA extracted from HS decoction treated with the anti-MIR2911 antagomir could not inhibit the VZV replication, demonstrating that VZV replication was specifically and sufficiently inhibited by MIR2911. These results indicated that, by targeting the IE62 gene, MIR2911 may effectively inhibit VZV replication. Our results also suggest a potential novel strategy for the treatment and prevention of diseases caused by VZV infection.
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Affiliation(s)
- Ying Huang
- Department of Pain, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Huabo Liu
- Department of Pain, Zhejiang Province Zhoushan Hospital, Zhoushan, Zhejiang, China
| | - Xinlei Sun
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210046, Jiangsu, China
| | - Meng Ding
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210046, Jiangsu, China
| | - Gaojian Tao
- Department of Pain, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
| | - Xihan Li
- Department of Gastroenterology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
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Lindahl JK, Friman V, Ladfors SW, Hansson S, Andersson R, Jertborn M, Woxenius S. Long-term study showed that vaccination protected paediatric renal transplant recipients from life-threatening varicella zoster virus. Acta Paediatr 2018; 107:2185-2192. [PMID: 29706010 PMCID: PMC6282574 DOI: 10.1111/apa.14375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/03/2018] [Accepted: 04/23/2018] [Indexed: 11/28/2022]
Abstract
AIM Renal transplant patients are particularly susceptible to highly contagious diseases due to their reduced immunity. We studied transplant recipients to gauge their varicella zoster virus (VZV) serology status over time and the outcome of any VZV infections. METHOD This retrospective study comprised 85 children who underwent renal transplants in Gothenburg, Sweden, from 1986 to 2014, at a mean age of eight (1-18) years. The children's medical records were reviewed and 47 had the VZV infection pre-transplant and 38 had been vaccinated pre-transplant. Clinical outcomes were available for 85 children and serology results for 72. RESULTS At transplantation, the VZV seropositivity rate was 50% in the vaccination group and 94% in the infection group and the antibody titres were significantly lower in the vaccination group (p = 0.031). During the median follow-up period of five years post-transplant, 28% of the vaccinated children and 97% of the infection group remained seropositive and the varicella infection affected eight children: one in the infection group and seven in the vaccination group. The herpes zoster was observed in two children in the infection group. CONCLUSION This study demonstrated that VZV vaccination protected from symptomatic infections to a lesser extent than natural infection, but provided effective protection from life-threatening disease.
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Affiliation(s)
- Jenny K. Lindahl
- Department of Infectious DiseasesSahlgrenska University HospitalGothenburgSweden
- Department of Infectious DiseasesInstitute of BiomedicineSahlgrenska AcademyGothenburg UniversityGothenburgSweden
| | - Vanda Friman
- Department of Infectious DiseasesSahlgrenska University HospitalGothenburgSweden
- Department of Infectious DiseasesInstitute of BiomedicineSahlgrenska AcademyGothenburg UniversityGothenburgSweden
| | - Susanne Westphal Ladfors
- Department of PaediatricsQueen Silvia Children's HospitalSahlgrenska University HospitalGothenburgSweden
- Department of PaediatricsInstitute of Clinical SciencesSahlgrenska AcademyGothenburg UniversityGothenburgSweden
| | - Sverker Hansson
- Department of PaediatricsQueen Silvia Children's HospitalSahlgrenska University HospitalGothenburgSweden
- Department of PaediatricsInstitute of Clinical SciencesSahlgrenska AcademyGothenburg UniversityGothenburgSweden
| | - Rune Andersson
- Department of Infectious DiseasesInstitute of BiomedicineSahlgrenska AcademyGothenburg UniversityGothenburgSweden
- Hospital Infection ControlDepartment of Clinical BacteriologySahlgrenska University HospitalGothenburgSweden
| | - Marianne Jertborn
- Department of Infectious DiseasesSahlgrenska University HospitalGothenburgSweden
- Department of Infectious DiseasesInstitute of BiomedicineSahlgrenska AcademyGothenburg UniversityGothenburgSweden
| | - Susanne Woxenius
- Department of Infectious DiseasesSahlgrenska University HospitalGothenburgSweden
- Department of Infectious DiseasesInstitute of BiomedicineSahlgrenska AcademyGothenburg UniversityGothenburgSweden
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Anti-varicella-zoster virus activity of cephalotaxine esters in vitro. J Microbiol 2018; 57:74-79. [PMID: 30456755 PMCID: PMC7090801 DOI: 10.1007/s12275-019-8514-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 12/31/2022]
Abstract
Harringtonine (HT) and homoharringtonine (HHT), alkaloid esters isolated from the genus Cephalotaxus, exhibit antitumor activity. A semisynthetic HHT has been approved for treatment of chronic myelogenous leukemia. In addition to antileukemic activity, HT and HHT are reported to possess potent antiviral activity. In this study, we investigated the effects of HT and HHT on replication of varicella-zoster virus (VZV) in vitro. HT and HHT, but not their biologically inactive parental alkaloid cephalotaxine (CET), significantly inhibited replication of recombinant VZV-pOka luciferase. Furthermore, HT and HHT, but not CET, strongly induced down-regulation of VZV lytic genes and exerted potent antiviral effects against a VZV clinical isolate. The collective data support the utility of HT and HHT as effective antiviral candidates for treatment of VZV-associated diseases.
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Yasui R, Yoshida C, Yamaguchi T, Inoue N. Characterization of an anti-varicella-zoster virus compound that targets the portal protein encoded by ORF54. Microbiol Immunol 2018; 61:398-402. [PMID: 28833387 DOI: 10.1111/1348-0421.12507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/05/2017] [Accepted: 08/12/2017] [Indexed: 12/01/2022]
Abstract
An anti-varicella-zoster virus compound, a 5-chlorobenzo[b]thiophen derivative (45B5), was characterized. Its 50% effective concentration against the cell-free vaccine Oka strain and 50% cytotoxic concentration in human fibroblasts were 16.9 µM and more than 100 µM, respectively. Treatment with 45B5 decreased viral DNA synthesis and IE62 expression weakly but significantly. All 45B5-resistant viral clones isolated were found to have at least one mutation in ORF54 that encodes the portal protein. There were no effects on interaction between the portal and scaffold proteins. Thus, 45B5 may inhibit nuclear delivery of viral DNA.
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Affiliation(s)
- Ruka Yasui
- Department of Microbiology and Immunology, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu-Shi, Gifu 501-1196, Japan
| | - Chinatsu Yoshida
- Department of Microbiology and Immunology, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu-Shi, Gifu 501-1196, Japan
| | - Toyofumi Yamaguchi
- Department of Biosciences, Teikyo University of Science, 2-2-1 Senju-Sakuragi, Adachi-ku, Tokyo 120-0045, Japan
| | - Naoki Inoue
- Department of Microbiology and Immunology, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu-Shi, Gifu 501-1196, Japan
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Affiliation(s)
- Alireza Khodabande
- Farabi Eye Research Center, Department of Ophthalmology, Tehran University of Medical Science, Tehran - Iran
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Bae S, Kim SY, Do MH, Lee CH, Song YJ. 1,2,3,4,6-Penta-O-galloyl-ß-D-glucose, a bioactive compound in Elaeocarpus sylvestris extract, inhibits varicella-zoster virus replication. Antiviral Res 2017; 144:266-272. [PMID: 28668556 DOI: 10.1016/j.antiviral.2017.06.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/19/2017] [Accepted: 06/28/2017] [Indexed: 12/18/2022]
Abstract
The aim of this study was to establish the effect of a 70% ethanol extract of Elaeocarpus sylvestris (ESE) on varicella-zoster virus (VZV) replication and identify the specific bioactive component(s) underlying its activity. ESE induced a significant reduction in replication of the clinical strain of VZV. Activity-guided fractionation indicated that the ethyl acetate (EtOAc) fraction of ESE contains the active compound(s) inhibiting VZV replication. High-Performance Liquid Chromatography coupled to Electrospray Ionization Quadrupole Time-of-Flight Mass Spectrometry (HPLC-Q-TOF-MS/MS) analysis of the EtOAc fraction of ESE facilitated the identification of 13 chemical components. Among these, 1,2,3,4,6-penta-O-galloyl-ß-D-glucose (PGG) markedly suppressed VZV-induced c-Jun N-terminal kinase (JNK) activation, expression of viral immediate-early 62 (IE62) protein and VZV replication. Our results collectively support the utility of PGG as a potential candidate anti-viral drug to treat VZV-associated diseases.
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Affiliation(s)
- Sohee Bae
- Department of Life Science, Gachon University, Seongnam-Si, Kyeonggi-Do, 13120, South Korea
| | - Sun Yeou Kim
- Laboratory of Pharmacognosy, College of Pharmacy, Gachon University, Incheon, 21936, South Korea
| | - Moon Ho Do
- Laboratory of Pharmacognosy, College of Pharmacy, Gachon University, Incheon, 21936, South Korea
| | - Chan Hee Lee
- Department of Microbiology, Chungbuk National University, Cheongju, 28644, South Korea
| | - Yoon-Jae Song
- Department of Life Science, Gachon University, Seongnam-Si, Kyeonggi-Do, 13120, South Korea.
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Arvin AM, Wolinsky JS, Kappos L, Morris MI, Reder AT, Tornatore C, Gershon A, Gershon M, Levin MJ, Bezuidenhoudt M, Putzki N. Varicella-zoster virus infections in patients treated with fingolimod: risk assessment and consensus recommendations for management. JAMA Neurol 2015; 72:31-9. [PMID: 25419615 DOI: 10.1001/jamaneurol.2014.3065] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Varicella-zoster virus (VZV) infections increasingly are reported in patients with multiple sclerosis (MS) and constitute an area of significant concern, especially with the advent of more disease-modifying treatments in MS that affect T-cell-mediated immunity. OBJECTIVE To assess the incidence, risk factors, and clinical characteristics of VZV infections in fingolimod-treated patients and provide recommendations for prevention and management. DESIGN, SETTING, AND PARTICIPANTS Rates of VZV infections in fingolimod clinical trials are based on pooled data from the completed controlled phases 2 and 3 studies (3916 participants) and ongoing uncontrolled extension phases (3553 participants). Male and female patients aged 18 through 55 years (18-60 years for the phase 2 studies) and diagnosed as having relapsing-remitting MS were eligible to participate in these studies. In the postmarketing setting, reporting rates since 2010 were evaluated. INTERVENTIONS In clinical trials, patients received fingolimod at a dosage of 0.5 or 1.25 mg/d, interferon beta-1a, or placebo. In the postmarketing setting, all patients received fingolimod, 0.5 mg/d (total exposure of 54,000 patient-years at the time of analysis). MAIN OUTCOMES AND MEASURES Calculation of the incidence rate of VZV infection per 1000 patient-years was based on the reporting of adverse events in the trials and the postmarketing setting. RESULTS Overall, in clinical trials, VZV rates of infection were low but higher with fingolimod compared with placebo (11 vs 6 per 1000 patient-years). A similar rate was confirmed in the ongoing extension studies. Rates reported in the postmarketing settings were comparable (7 per 1000 patient-years) and remained stable over time. Disproportionality in reporting herpes zoster infection was higher for patients receiving fingolimod compared with those receiving other disease-modifying treatments (empirical Bayes geometric mean, 2.57 [90% CI, 2.26-2.91]); the proportion of serious herpes zoster infections was not higher than the proportion for other treatments (empirical Bayes geometric mean, 1.88 [90% CI, 0.87-3.70]). Corticosteroid treatment for relapses might be a risk factor for VZV reactivation. CONCLUSIONS AND RELEVANCE Rates of VZV infections in clinical trials were low with fingolimod, 0.5 mg/d, but higher than in placebo recipients. Rates reported in the postmarketing setting are comparable. We found no sign of risk accumulation with longer exposure. Serious or complicated cases of herpes zoster were uncommon. We recommend establishing the patient's VZV immune status before initiating fingolimod therapy and immunization for patients susceptible to primary VZV infection. Routine antiviral prophylaxis is not needed, but using concomitant pulsed corticosteroid therapy beyond 3 to 5 days requires an individual risk-benefit assessment. Vigilance to identify early VZV symptoms is important to allow timely antiviral treatment.
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Affiliation(s)
- Ann M Arvin
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jerry S Wolinsky
- Department of Neurology, The University of Texas Health Science Center at Houston
| | - Ludwig Kappos
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Michele I Morris
- Department of Infectious Diseases, University of Miami, Miami, Florida
| | - Anthony T Reder
- Department of Neurology, University of Chicago Medical Center, Chicago, Illinois
| | - Carlo Tornatore
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC
| | - Anne Gershon
- Department of Pediatrics, Columbia University, New York, New York
| | - Michael Gershon
- Department of Pathology and Cell Biology, Columbia University, New York, New York
| | - Myron J Levin
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
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Patel SR, Bate J, Maple PAC, Brown K, Breuer J, Heath PT. Varicella zoster immune status in children treated for acute leukemia. Pediatr Blood Cancer 2014; 61:2077-9. [PMID: 24789692 DOI: 10.1002/pbc.25086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/09/2014] [Indexed: 11/07/2022]
Abstract
Children treated for acute leukemia are at increased risk of severe infection with varicella zoster virus (VZV). We studied the VZV sero-status of children with acute leukemia prior to starting chemotherapy and after completion of chemotherapy. VZV sero-status was assessed using time resolved fluorescence immunoassay (TRFIA) before starting treatment and 6 months after completion of treatment. Prior to starting treatment for acute leukemia, a significant proportion of children (35%) are VZV seronegative. On completion of treatment most patients maintained protective VZV antibody levels; however, 35% had reduced/loss VZV antibody to a level considered non-protective and susceptible to VZV infection.
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Affiliation(s)
- Soonie R Patel
- Paediatric Department, Croydon University Hospital, Croydon, UK
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12
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Paintsil E, Cheng YC. Antiviral Agents☆. REFERENCE MODULE IN BIOMEDICAL SCIENCES 2014. [PMCID: PMC7150273 DOI: 10.1016/b978-0-12-801238-3.02387-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Antiviral agents are drugs approved in the USA by the Food and Drug Administration (FDA) for the treatment or control of viral infections. Available antiviral agents mainly target stages in the viral life cycle. The target stages in the viral life cycle are; viral attachment to host cell, uncoating, synthesis of viral mRNA, translation of mRNA, replication of viral RNA and DNA, maturation of new viral proteins, budding, release of newly synthesized virus, and free virus in body fluids. Two important factors that can limit the utility of antiviral drugs are toxicity and the development of resistance to the antiviral agent by the virus. In addition, host phenotypic behaviors toward antiviral drugs because of either genomic or epigenetic factors could limit the efficacy of an antiviral agent in an individual. This article summarizes the most relevant pharmacologic and clinical properties of current antiviral agents, and targets for novel antiviral agents.
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Weller SK, Kuchta RD. The DNA helicase-primase complex as a target for herpes viral infection. Expert Opin Ther Targets 2013; 17:1119-32. [PMID: 23930666 DOI: 10.1517/14728222.2013.827663] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The Herpesviridae are responsible for debilitating acute and chronic infections, and some members of this family are associated with human cancers. Conventional anti-herpesviral therapy targets the viral DNA polymerase and has been extremely successful; however, the emergence of drug-resistant virus strains, especially in neonates and immunocompromised patients, underscores the need for continued development of anti-herpes drugs. In this article, we explore an alternative target for antiviral therapy, the HSV helicase/primase complex. AREAS COVERED This review addresses the current state of knowledge of HSV DNA replication and the important roles played by the herpesvirus helicase- primase complex. In the last 10 years several helicase/primase inhibitors (HPIs) have been described, and in this article, we discuss and contrast these new agents with established inhibitors. EXPERT OPINION The outstanding safety profile of existing nucleoside analogues for α-herpesvirus infection make the development of new therapeutic agents a challenge. Currently used nucleoside analogues exhibit few side effects and have low occurrence of clinically relevant resistance. For HCMV, however, existing drugs have significant toxicity issues and the frequency of drug resistance is high, and no antiviral therapies are available for EBV and KSHV. The development of new anti-herpesvirus drugs is thus well worth pursuing especially for immunocompromised patients and those who develop drug-resistant infections. Although the HPIs are promising, limitations to their development into a successful drug strategy remain.
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Affiliation(s)
- Sandra K Weller
- University of Connecticut Health Center, Department of Molecular Microbial and Structural Biology , Farmington CT 06030 , USA +1 860 679 2310 ;
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Prichard MN, Williams JD, Komazin-Meredith G, Khan AR, Price NB, Jefferson GM, Harden EA, Hartline CB, Peet NP, Bowlin TL. Synthesis and antiviral activities of methylenecyclopropane analogs with 6-alkoxy and 6-alkylthio substitutions that exhibit broad-spectrum antiviral activity against human herpesviruses. Antimicrob Agents Chemother 2013; 57:3518-27. [PMID: 23669381 PMCID: PMC3719742 DOI: 10.1128/aac.00429-13] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 05/06/2013] [Indexed: 11/20/2022] Open
Abstract
Methylenecyclopropane nucleosides have been reported to be active against many of the human herpesviruses. The most active compound of this class is cyclopropavir (CPV), which exhibits good antiviral activity against human cytomegalovirus (HCMV), Epstein-Barr virus, both variants of human herpesvirus 6, and human herpesvirus 8. CPV has two hydroxymethyl groups on the methylenecyclopropane ring, but analogs with a single hydroxymethyl group, such as the prototypical (S)-synguanol, are also active and exhibit a broader spectrum of antiviral activity that also includes hepatitis B virus and human immunodeficiency virus. Here, a large set of monohydroxymethyl compounds with ether and thioether substituents at the 6 position of the purine was synthesized and evaluated for antiviral activity against a range of human herpesviruses. Some of these analogs had a broader spectrum of antiviral activity than CPV, in that they also inhibited the replication of herpes simplex viruses 1 and 2 and varicella-zoster virus. Interestingly, the antiviral activity of these compounds appeared to be dependent on the activity of the HCMV UL97 kinase but was relatively unaffected by the absence of thymidine kinase activity in HSV. These data taken together indicate that the mechanism of action of these analogs is distinct from that of CPV. They also suggest that they might be useful as broad-spectrum antiherpesvirus agents and may be effective in the treatment of resistant virus infections.
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Affiliation(s)
- Mark N Prichard
- University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Soeteman M, Willems RPP, Busari JO. Herpes zoster ophthalmicus in an otherwise healthy 2-year-old child. BMJ Case Rep 2012; 2012:bcr-2012-007015. [PMID: 23112258 DOI: 10.1136/bcr-2012-007015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The following report describes a previously healthy 2-year-old girl with herpes zoster ophthalmicus (HZO). The child presented with a painless vesicular skin eruption covering the left forehead. There was only a history of household exposure to varicella zoster virus (VZV) and the child had not been vaccinated against VZV. PCR assays on vesicular fluid identified VZV DNA. Treatment with acyclovir was started early in the clinical course. In addition, the girl was treated with locally administered ophthalmological acyclovir ointment. Besides some dermal excoriations, a complete resolution of the HZO was achieved without sequelae.
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Affiliation(s)
- Marijn Soeteman
- Department of Paediatrics, Atrium Medical Center, Heerlen, Netherlands
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Identification of a varicella-zoster virus replication inhibitor that blocks capsid assembly by interacting with the floor domain of the major capsid protein. J Virol 2012; 86:12198-207. [PMID: 22933294 DOI: 10.1128/jvi.01280-12] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A novel anti-varicella-zoster virus compound, a derivative of pyrazolo[1,5-c]1,3,5-triazin-4-one (coded as 35B2), was identified from a library of 9,600 random compounds. This compound inhibited both acyclovir (ACV)-resistant and -sensitive strains. In a plaque reduction assay under conditions in which the 50% effective concentration of ACV against the vaccine Oka strain (V-Oka) in human fibroblasts was 4.25 μM, the 50% effective concentration of 35B2 was 0.75 μM. The selective index of the compound was more than 200. Treatment with 35B2 inhibited neither immediate-early gene expression nor viral DNA synthesis. Twenty-four virus clones resistant to 35B2 were isolated, all of which had a mutation(s) in the amino acid sequence of open reading frame 40 (ORF40), which encodes the major capsid protein (MCP). Most of the mutations were located in the regions corresponding to the "floor" domain of the MCP of herpes simplex virus 1. Treatment with 35B2 changed the localization of MCP in the fibroblasts infected with V-Oka but not in the fibroblasts infected with the resistant clones, although it did not affect steady-state levels of MCP. Overexpression of the scaffold proteins restored the normal MCP localization in the 35B2-treated infected cells. The compound did not inhibit the scaffold protein-mediated translocation of MCP from the cytoplasm to the nucleus. Electron microscopic analysis demonstrated the lack of capsid formation in the 35B2-treated infected cells. These data indicate the feasibility of developing a new class of antivirals that target the herpesvirus MCPs and inhibit normal capsid formation by a mechanism that differs from those of the known protease and encapsidation inhibitors. Further biochemical studies are required to clarify the precise antiviral mechanism.
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De Broucker T, Mailles A, Chabrier S, Morand P, Stahl JP. Acute varicella zoster encephalitis without evidence of primary vasculopathy in a case-series of 20 patients. Clin Microbiol Infect 2012; 18:808-19. [DOI: 10.1111/j.1469-0691.2011.03705.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Clinical Guidelines for the Treatment and Prevention of Opportunistic Infections in HIV-infected Koreans. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.3.93] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Preventing varicella in children with malignancies: what is the evidence? Curr Opin Infect Dis 2011; 24:203-11. [PMID: 21455062 DOI: 10.1097/qco.0b013e328345d666] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The prevention of varicella in children with cancer is generally agreed to be an important goal, because of their elevated risk of varicella zoster virus (VZV)-associated morbidity and mortality. However, there is a lack of consensus on the best means of achieving this. Here, we review the existing evidence in relation to postexposure prophylaxis against varicella in this group and summarize data regarding the role of active vaccination. RECENT FINDINGS Death from varicella during treatment for cancer is now rare, but VZV disease and its prevention remain significant problems in paediatric oncology practice. Measures to reduce VZV exposure amongst seronegative individuals are often neglected. When exposure is known to have occurred, early administration of varicella zoster immune globulin (VZIG) is generally protective against severe and complicated varicella. However, many centres in the UK and Japan use an oral antiviral agent, aciclovir, in place of VZIG. Published evidence for the efficacy of aciclovir as postexposure prophylaxis (PEP) relates mostly to healthy children, with no controlled studies in the immunocompromised. SUMMARY Good evidence already supports the administration of varicella vaccine to healthy susceptible family contacts of children with malignancy, but not to patients themselves. Further data are urgently needed to inform the choice of PEP against VZV in the immunocompromised.
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Abstract
Chicken pox is an infectious childhood disease. It is rare in infants and newborns due to passive immunity received from the mother. The characteristic skin eruptions in chicken pox are vesicular with erythematous base and accompanied with pruritus. The skin of the palms and soles is typically spared. We report a case of neonatal varicella where the mother was having skin eruptions at the time of delivery and the neonate contracted it during the perinatal period and developed clinical disease on the day five of life. Specific anti-viral therapy was given to the mother and the baby and the recovery was uneventful.
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Affiliation(s)
- Ak Bhardwaj
- Professor, Department of Pediatrics, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
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Chono K, Katsumata K, Kontani T, Kobayashi M, Sudo K, Yokota T, Konno K, Shimizu Y, Suzuki H. ASP2151, a novel helicase-primase inhibitor, possesses antiviral activity against varicella-zoster virus and herpes simplex virus types 1 and 2. J Antimicrob Chemother 2010; 65:1733-41. [PMID: 20534624 DOI: 10.1093/jac/dkq198] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To evaluate and describe the anti-herpesvirus effect of ASP2151, amenamevir, a novel non-nucleoside oxadiazolylphenyl-containing herpesvirus helicase-primase complex inhibitor. METHODS The inhibitory effect of ASP2151 on enzymatic activities associated with a recombinant HSV-1 helicase-primase complex was assessed. To investigate the effect on viral DNA replication, we analysed viral DNA in cells infected with herpesviruses [herpes simplex virus (HSV), varicella-zoster virus (VZV) and human cytomegalovirus]. Sequencing analyses were conducted on an ASP2151-resistant VZV mutant. In vitro and in vivo antiviral activities were evaluated using a plaque reduction assay and an HSV-1-infected zosteriform-spread model in mice. RESULTS ASP2151 inhibited the single-stranded DNA-dependent ATPase, helicase and primase activities associated with the HSV-1 helicase-primase complex. Antiviral assays revealed that ASP2151, unlike other known HSV helicase-primase inhibitors, exerts equipotent activity against VZV, HSV-1 and HSV-2 through prevention of viral DNA replication. Further, the anti-VZV activity of ASP2151 (EC(50), 0.038-0.10 microM) was more potent against all strains tested than that of aciclovir (EC(50), 1.3-27 microM). ASP2151 was also active against aciclovir-resistant VZV. Amino acid substitutions were found in helicase and primase subunits of ASP2151-resistant VZV. In a mouse zosteriform-spread model, ASP2151 was orally active and inhibited disease progression more potently than valaciclovir. CONCLUSIONS ASP2151 is a novel herpes helicase-primase inhibitor that warrants further investigation for the potential treatment of both VZV and HSV infections.
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Affiliation(s)
- Koji Chono
- Drug Discovery Research, Astellas Pharma Inc., Tokyo, Japan
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22
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Chiner E, Ballester I, Betlloch I, Blanquer J, Aguar MC, Blanquer R, Fernández-Fabrellas E, Andreu AL, Briones M, Sanz F. Varicella-zoster virus pneumonia in an adult population: has mortality decreased? ACTA ACUST UNITED AC 2010; 42:215-21. [PMID: 20055724 DOI: 10.3109/00365540903428166] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Varicella-zoster virus (VZV) pneumonia is one of the most serious complications of this infection in adults. The objective of this study was to analyze the epidemiological and clinical characteristics in a large sample of patients with VZV pneumonia. This was a 10-y retrospective, descriptive, observational study. We studied 46 patients with VZV pneumonia, 21 men and 25 women, with a mean age 36 +/-11 y. A contact with an index case was observed in 57%, 76 were active smokers, 6.5% consumed drugs and 2 women were pregnant. The symptoms were: fever (83%), cough (83%), dyspnoea (63%), pleuritic pain (70%), and haemoptysis (6%) and started 3-5 days after the onset of blisters, except in 11% in whom respiratory symptoms appeared first. Arterial blood gases showed a mean PO(2)/FiO(2) of 308 +/-101 and 30 patients had a PO(2) of <55 mmHg--11 of these (4%) were admitted to the ICU, 8 required mechanical ventilation. Comparison of patients in the ICU with those on the general ward showed differences in the duration of fever (6.1 +/- 4.2 vs 3.2 +/- 1.1 days, p <0.001), mean stay (16.8+/-9.3 vs 7.2+/-2.4 days, p <0.001) and complications such as acute renal failure (p = 0.01) and acute respiratory failure (p < 0.001). Despite the severity of disease, no patient died. Once diagnosed, 98% were treated with acyclovir, combined with steroids in 6 and with antibiotics in 3 complicated with bacterial pneumonia. The prevalence for the period was 0.33 cases/100,000 inhabitants/y. In conclusion, VZV pneumonia has a severe course and accounts for a high percentage of admissions to the intensive care unit. The absence of mortality may be related to early treatment with acyclovir. Smoking was a risk factor for VZV pneumonia.
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Affiliation(s)
- Eusebi Chiner
- Pneumology Section, Hospital Universitario San Juan de Alicante, Spain.
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23
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Mustafa MB, Arduino PG, Porter SR. Varicella zoster virus: review of its management. J Oral Pathol Med 2009; 38:673-88. [DOI: 10.1111/j.1600-0714.2009.00802.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Dehecq C, Wibaux A, Valette M, Viget N, Baclet V, Yazdanpanah Y, Senneville E. Étude rétrospective de 106 cas de varicelle chez l’adulte immunocompétent. Paramètres associés à la pneumonie varicelleuse. Med Mal Infect 2009; 39:101-7. [DOI: 10.1016/j.medmal.2008.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 05/27/2008] [Accepted: 09/30/2008] [Indexed: 10/21/2022]
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25
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Paintsil E, Cheng YC. Antiviral Agents. ENCYCLOPEDIA OF MICROBIOLOGY 2009. [PMCID: PMC7149689 DOI: 10.1016/b978-012373944-5.00178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Wang GQ, Suzutani T, Yamamoto Y, Fukui Y, Nozawa N, Schmid DS, Kurane I, Inoue N. Generation of a reporter cell line for detection of infectious varicella-zoster virus and its application to antiviral studies. Antimicrob Agents Chemother 2006; 50:3142-5. [PMID: 16940113 PMCID: PMC1563536 DOI: 10.1128/aac.00342-06] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To simplify the titration of infectious varicella-zoster virus (VZV), we generated a reporter cell line that produced luciferase in a dose-dependent manner upon infection with cell-free VZV. A few VZV-infected cells were detectable by coculturing with the cell line. We demonstrated the usefulness of the cell line for antiviral studies.
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Affiliation(s)
- Guan-Qing Wang
- Department of Virology I, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo 162-8640, Japan
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Abstract
Varicella-zoster virus (VZV), the cause of chickenpox and shingles, is a pathogen in retreat following the introduction of mass vaccination in the United States in 1995. The live attenuated Oka vaccine, which is safe and immunogenic, gives good protection against both varicella and zoster in the short to medium term. It has undoubtedly been highly effective to date in reducing all forms of varicella, especially severe disease. However, the huge pool of latent wild-type virus in the population represents a continuing threat. Both the biology and the epidemiology of VZV disease suggest that new vaccination strategies will be required over time.
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Affiliation(s)
- Sophie Hambleton
- Columbia University College of Physicians and Surgeons, 650 W. 168th Street, New York, NY 10032, USA
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28
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Davis MM, Patel MS, Gebremariam A. Decline in varicella-related hospitalizations and expenditures for children and adults after introduction of varicella vaccine in the United States. Pediatrics 2004; 114:786-92. [PMID: 15342855 DOI: 10.1542/peds.2004-0012] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Universal childhood immunization against varicella in the United States, first recommended in 1995, was predicted to lead to significant decreases in varicella-related hospitalization rates and corresponding charges. Previous studies have not found such effects. We studied trends in varicella-related hospitalization rates and associated charges before and after introduction of varicella vaccine. METHODS We examined hospitalization and charge data from the Nationwide Inpatient Sample for the years 1993-2001, representative of national hospitalization patterns for children and adults. We derived weighted estimates of population-adjusted, varicella-related hospitalization rates and inflation-adjusted, varicella-related hospital charges. RESULTS The annual varicella-related hospitalization rate exceeded 0.5 hospitalizations per 10,000 US population from 1993 to 1995, declined to 0.26 per 10,000 by 1999, and again halved to 0.13 per 10,000 by 2001. Hospitalization rates declined most substantially among individuals primarily targeted for vaccination (0- to 4-year-old children) but decreased among youths aged 5 to 19 years and among adults as well. Concomitantly, varicella-related hospital charges declined from 161.1 million dollars (95% confidence interval: 130.5 million dollars-191.8 million dollars) in 1993 to 66.3 million dollars (95% confidence interval: 50.9 million dollars-81.7 million dollars) in 2001 (all 2001 US dollars). Among expected primary payers, inflation-adjusted declines in varicella-related hospital discharges-related charges accrued to Medicaid, private insurance, and "other" payers (including uninsured and self-pay) but not to Medicare. CONCLUSIONS This national analysis indicates a clinically and statistically significant reduction in varicella-related hospitalizations for children and adults associated with childhood varicella immunization in the United States and a corresponding significant decrease in hospital charges.
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Affiliation(s)
- Matthew M Davis
- Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan 48109-0456, USA.
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29
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Prober CG. New antivirals and antiviral resistance. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2004; 549:9-12. [PMID: 15250510 DOI: 10.1007/978-1-4419-8993-2_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Charles G Prober
- Department of Pediatrics, Stanford University School of Medicine, USA
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Pignotti MS, Indolfi G, Messineo A, Donzelli G. Aseptic meningitis in neonatal varicella complicated by Escherichia coil sepsis. Eur J Pediatr 2004; 163:343-4. [PMID: 15346924 DOI: 10.1007/s00431-004-1435-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Maria Serenella Pignotti
- Neonatal Intensive Care Unit, Anna Meyer Children's Hospital, via Luca Giordano 13, 50132 Firenze, Italy.
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Tangsinmankong N, Kamchaisatian W, Lujan-Zilbermann J, Brown CL, Sleasman JW, Emmanuel PJ. Varicella zoster as a manifestation of immune restoration disease in HIV-infected children. J Allergy Clin Immunol 2004; 113:742-6. [PMID: 15100682 DOI: 10.1016/j.jaci.2004.01.768] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Exacerbation of opportunistic infections in HIV-infected patients shortly after initiation of highly active antiretroviral therapy (HAART) has been named immune restoration disease (IRD). Thus far, IRD has not been reported in children. OBJECTIVE We describe the clinical and immune characteristics of IRD in HIV-infected children treated with HAART. METHODS A historical cohort study was conducted in a tertiary HIV center in perinatally HIV-infected children who were started on a first stable HAART between January 1996 and July 2002. The incidence of opportunistic infections, newly AIDS-defining events or death after initiation of HAART, and virologic and immunologic information was evaluated at baseline and every 3 months post-HAART. RESULTS Sixty-one perinatally HIV-infected children were started and maintained on HAART for >6 months. Seven episodes of IRD occurred. All were cutaneous herpes zoster (HZ). Children who developed HZ had significantly lower baseline CD4+ and CD8+ T-cell numbers compared with children who did not. HZ occurred only in children (7 of 34 subjects) with virological and immunological success to HAART. In children with a previous history of varicella infection, the risk of developing HZ after HAART was higher in those without a protective level of varicella-specific IgG (50%, or 5 of 10 subjects) compared with those with seroprotection (10%, or 2 of 20). CONCLUSION Herpes zoster is a common manifestation of IRD in HIV-infected children after the initiation of HAART. Risks for developing HZ include no protective varicella-specific antibody despite previous varicella infection, severe immunodeficiency at baseline, and vigorous immunologic and virologic responses to HAART.
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Affiliation(s)
- Nutthapong Tangsinmankong
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida/All Children's Hospital, 801 Sixth Street South, Box 9350, St Petersburg, FL 33701, USA.
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