Infections in transplant patient

Valacyclovir is indicated for the treatment of herpes zoster (shingles), for the treatment of initial and recurrent episodes of genital herpes, and for the suppression of recurrent genital herpes in immunocompetent and HIV-infected patients. It is also indicated for the reduction of transmission of genital herpes in immunocompetent individuals, and for the treatment of cold sores. Valacyclovir appears to be equally effective in treating herpes zoster and recurrent genital herpes in immunocompetent adults. Valacyclovir has shown efficacy in the prophylaxis of cytomegalovirus infections in transplant patients (Perry and Faulds, 1996). 

The role of mycophenolate in the rate and severity of cjdomegalovirus infection in transplant patients has been debated (SEDA-23, 407) and is difficult to evaluate in otherwise immunosuppressed patients. Whereas there was a dose-related increase in the incidence of cytomegalovirus disease in the three pivotal trials, a later analysis did not confirm that mycophenolate mofetil is specifically associated with an increased risk of cytomegalovirus infection, and suggested that over-immunosuppression rather than mycophenolate mofetil per se was the main contributing factor (SEDA-22, 418) (27-29). 

Herpes simplex virus (HSV) infections in transplant patients are most commonly the result of reactivation of a previous infection. Symptomatic HSV infection usually presents as labial or oral lesions in the first 1 to 3 months after transplantation, but patients also may present with reactivation of varicella-zoster as shingles. Prophylactic therapy with low-dose oral acyclovir delays the development of HSV infections in patients following transplantation. 

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