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Acyclovir may have long-term neurodevelopmental benefits in neonatal HSV
Kimberlin DW. N Engl J Med. 2011;365:1284-1292.
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Infants with central nervous system involvement associated with herpes simplex virus infection had improved neurodevelopmental outcomes after treatment with acyclovir, according to study results.
Neonates with herpes simplex virus (HSV) disease were enrolled in two parallel, identical, double blind, placebo-controlled studies. One study comprised 45 infants with central nervous system involvement, and the other study comprised 29 infants with skin, eye and mouth involvement.
A 14- to 21-day regimen of parenteral acyclovir was completed by all infants. After the regimen was completed, the infants were assigned to 300 mg/m2 of body surface area per dose orally, three times daily for 6 months, or placebo.
Clinicians treated cutaneous recurrences with open-label episodic therapy. David W. Kimberlin, MD, a member of the Infectious Diseases in Children Editorial Board, and colleagues, used the Mental Development Index of the Bayley Scales of Infant Development — in which scores range from 50 to 150, with a mean of 100 and with higher scores indicating better neurodevelopmental outcomes — to assess 28 of the 45 infants with central nervous system involvement at age 12 months.
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Infants in the central nervous system cohort who had been assigned the study drug had significantly higher scores on the Bayley scale at 12 months than infants who had been assigned placebo (88.24 vs. 68.12, P=.046). Overall results indicated that infants in the acyclovir group also trended toward neutropenia compared with infants in the placebo group (P=.09).
“Poor neurodevelopmental outcomes and recurrences of cutaneous lesions remain unacceptably frequent among survivors of neonatal HSV disease,” the researchers wrote. “Infants surviving neonatal HSV disease with [central nervous system] involvement had improved neurodevelopmental outcomes when they received suppressive therapy with oral acyclovir for 6 months.”
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