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Mindel A. Long term oral acyclovir in disseminated mucocutaneous herpes simplex: a case report. Br J Vener Dis 1984; 60:125–6.
Prior to the advent of acyclovir, the management of herpes simplex virus disease was highly variable and extremely inconsistent across clinics. The mainstay of therapy had been short-term topical idoxuridine with a variety of additional therapies often used in conjunction—oral and topical antibiotics, steroids and analgesics all had their advocates with little evidence that any one combination of therapies was ideal.
Acyclovir was patented in 1979 and studies of its use started appearing in the journals in the early 1980s. Concerns around toxicity limited early development and trials moved slowly from topical use to management of primary episodes with intravenous acyclovir (which were thought to justify the possible risks of therapy). The journal had seen a previous paper on acyclovir cream but the Mindel case report is the first important publication (in the literature) of continuous suppressive oral therapy.
Early recognition of acyclovir’s limited oral bioavailability and the easy induction of resistance to the drug in laboratory culture had led to limited expectations and concerns for oral therapy. The patient in the case had severe recurrent disseminated disease which was significantly milder on oral therapy but returned on acyclovir discontinuation after 12 weeks. The case represents an important demonstration of principle for the utility and effectiveness of oral suppressive acyclovir therapy—confirmed through the large placebo-controlled study published later the same year by the Seattle group.
In the paper, Mindel recognises the value of this new medication but raises the issue of long-term toxicity, resistance, psychological dependence and teratogenicity—questions that would take another 20 years to resolve.
Handling editor Jackie Cassell
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
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