Shingles Research Today is a free monthly online journal that collates and summarizes the latest research about Shingles, including details on symptoms, treatment, causes, virus.

Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients.

Hodson E, Craig J, Strippoli G, Webster A

BACKGROUND: The risk of cytomegalovirus (CMV) infection in solid organ transplant recipients has resulted in the frequent use of prophylaxis with the aim of preventing the clinical syndrome associated with CMV infection. OBJECTIVES: To determine the benefits and harms of antiviral medications to prevent CMV disease and all-cause mortality in solid organ transplant recipients. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, reference lists and abstracts from conference proceedings without language restriction.Date of last search: February 2007 SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs comparing antiviral medications with placebo or no treatment, comparing different antiviral medications and comparing different regimens of the same antiviral medications in recipients of any solid organ transplant. DATA COLLECTION AND ANALYSIS: Statistical analyses were performed using the random effects model and results expressed as relative risk (RR) for dichotomous outcomes with 95% confidence intervals (CI). Subgroup analysis and univariate meta-regression were performed using restricted maximum-likelihood to estimate the between study variance. Multivariate meta-regression was performed to investigate whether the results were altered after allowing for differences in drugs used, organ transplanted and recipient CMV serostatus at the time of transplantation. MAIN RESULTS: Thirty four studies (3850 participants) were identified. Prophylaxis with aciclovir, ganciclovir or valaciclovir compared with placebo or no treatment significantly reduced the risk for CMV disease (19 studies; RR 0.42, 95% CI 0.34 to 0.52), CMV infection (17 studies; RR 0.61, 95% CI 0.48 to 0.77), and all-cause mortality (17 studies; RR 0.63, 95% CI 0.43 to 0.92) primarily due to reduced mortality from CMV disease (7 studies; RR 0.26, 95% CI 0.08 to 0.78). Prophylaxis reduced the risk of herpes simplex and herpes zoster disease, bacterial and protozoal infections but not fungal infection, acute rejection or graft loss. Meta-regression showed no significant difference in the relative benefit of treatment (risk of CMV disease or all-cause mortality) by organ transplanted or CMV serostatus; no conclusions were possible for CMV negative recipients of negative organs. In direct comparison studies, ganciclovir was more effective than aciclovir in preventing CMV disease (7 studies; RR 0.37, 95% CI 0.23 to 0.60). Valganciclovir and IV ganciclovir were as effective as oral ganciclovir. AUTHORS' CONCLUSIONS: Prophylaxis with antiviral medications reduces CMV disease and CMV-associated mortality in solid organ transplant recipients. They should be used routinely in CMV positive recipients and in CMV negative recipients of CMV positive organ transplants.

Published 21 April 2008 in Cochrane Database Syst Rev.
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Articles on Shingles published 18 April 2008:

Varicella-zoster virus-specific immune responses in elderly recipients of a herpes zoster vaccine.   J Infect Dis, 197(6): 825-35.

BACKGROUND: A double-blind, placebo-controlled trial that involved 38,546 subjects > or =60 years old demonstrated efficacy of a high-potency live-attenuated Oka/Merck varicella-zoster virus (VZV) vaccine. The trial included an immunology substudy to determine the relationship of VZV-specific immune responses to vaccination and clinical outcome. METHODS: The immunology substudy enrolled 1395 subjects at 2 sites where blood samples obtained prior to vaccination, at 6 weeks after vaccination, ... [Abstract] [Full-text]

Articles on Shingles published 9 April 2008:

Reproductive health issues in rural Western Kenya.   Reprod Health, 5: 1.

ABSTRACT: BACKGROUND: We describe reproductive health issues among pregnant women in a rural area of Kenya with a high coverage of insecticide treated nets (ITNs) and high prevalence of HIV (15%). METHODS: We conducted a community-based cross-sectional survey among rural pregnant women in western Kenya. A medical, obstetric and reproductive history was obtained. Blood was obtained for a malaria smear and haemoglobin level, and stool was examined for geohelminths. Height and weight were ... [Abstract] [Full-text]

Articles on Shingles published 3 April 2008:

Prevalence and risk factors for carcinogenic human papillomavirus infections in rural Rakai, Uganda.   Sex Transm Infect.

OBJECTIVE: To investigate self-administered vaginal swabs for assessing prevalence and correlates of carcinogenic HPV infection in rural Rakai, Uganda. METHODS: 1,003 sexually experienced women enrolled in a community cohort provided self-administered vaginal swab collected at annual, home-based surveys. Carcinogenic HPV prevalence, adjusted odds ratios (AOR), 95% confidence intervals (95%CI), and associated risk factors were determined. RESULTS: Carcinogenic HPV prevalence was 19.2%; 46.6% ... [Abstract] [Full-text]

Articles on Shingles published 28 March 2008:

Association of varicella zoster virus load in the aqueous humor with clinical manifestations of anterior uveitis in herpes zoster ophthalmicus and zoster sine herpete.   Br J Ophthalmol, 92(4): 505-8.

AIM: To investigative whether clinical manifestations of anterior uveitis are associated with the viral load of varicella zoster virus (VZV) in the aqueous humor in patients with herpes zoster ophthalmicus (HZO) and zoster sine herpete (ZSH). METHODS: After informed consent was given, an aliquot of aqueous humor was collected from patients with VZV anterior uveitis (n = 8). Genomic DNA of the human herpes viruses was measured in the aqueous humor by two PCR assays: a qualitative multiplex PCR ... [Abstract] [Full-text]

Articles on Shingles published 27 March 2008:

Health care expenditure burden of persisting herpes zoster pain.   Pain Med, 9(3): 348-53.

OBJECTIVES: Pain can persist long after the resolution of herpes zoster, but little is known regarding its health care costs. The objective of this study was to determine the health care expenditures associated with persisting pain following herpes zoster by comparing expenditures for patients with postherpetic neuralgia or subacute herpetic neuralgia with a control group without these conditions. METHODS: Health care expenditures attributable to persisting pain in herpes zoster patients were ... [Abstract] [Full-text]

Articles on Shingles published 26 March 2008:

Mechanisms of varicella-zoster virus neuropathogenesis in human dorsal root ganglia.   J Virol, 82(8): 3971-83.

Varicella-zoster virus (VZV) is a human alphaherpesvirus that infects sensory ganglia and reactivates from latency to cause herpes zoster. VZV replication was examined in human dorsal root ganglion (DRG) xenografts in mice with severe combined immunodeficiency using multiscale correlative immunofluorescence and electron microscopy. These experiments showed the presence of VZV genomic DNA, viral proteins, and virion production in both neurons and satellite cells within DRG. Furthermore, the ... [Abstract] [Full-text]

Articles on Shingles published 25 March 2008:

Risk of multiple myeloma and monoclonal gammopathy of undetermined significance among white and black male United States veterans with prior autoimmune, infectious, inflammatory, and allergic disorders.   Blood, 111(7): 3388-94.

In a retrospective cohort of more than 4 million white and black male United States (US) veterans, we explored the role of specific prior autoimmune, infectious, inflammatory, and allergic disorders in the etiology of multiple myeloma (MM) and monoclonal gammopathy of undetermined significance (MGUS). Patients were selected from computerized inpatient discharge records at US Veterans Affairs hospitals. The analysis included 4641 patients (3040 white, 1601 black) and 2046 patients (1312 white; ... [Abstract] [Full-text]

Deep corneal calcification associated with preservative-free eyedrops and persistent epithelial defects.   Cornea, 27(3): 292-6.

PURPOSE: To describe the formation of deep calcareous degeneration of the cornea associated with the use of preservative-free eyedrops in patients with a persistent epithelial defect and active ocular surface inflammation. METHODS: A case series of 6 patients with persistent epithelial defects (1 with diabetes, 3 with penetrating keratoplasty, and 2 with herpes zoster) treated with preservative-free medications was reviewed over 18 months. Each patient subsequently developed deep calcareous ... [Abstract] [Full-text]

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