ABSTRACT
Our objective was to evaluate valaciclovir for anogenital herpes in HIV-infected individuals using 2 controlled trials conducted before highly active antiretroviral therapy (HAART) was used. In Study 1, 1062 patients (CD4+ > or = 100 cells/mm(3)) received suppressive valaciclovir or aciclovir for one year and were assessed monthly. In Study 2, 467 patients were treated episodically for > or =5 days with valaciclovir or aciclovir and evaluated daily. Valaciclovir was as effective as aciclovir for suppression and episodic treatment of herpes. Hazard ratios [95% confidence interval (CI)] for time to recurrence for valaciclovir 500 mg twice daily and 1000 mg once daily vs aciclovir were 0.73[0.50, 1.06], P=0.10, and 1.31[0.94, 1.82], P=0.11. Valaciclovir 500 mg twice daily was superior to 1000 mg once daily, P=0.001. Valaciclovir 1000 mg twice daily was comparable to aciclovir on herpes episode duration (hazard ratio 0.92[0.75, 1.14]). Adverse events were similar among treatments. In conclusion, valaciclovir is a safe, effective, convenient alternative to aciclovir for HSV infection in HIV-infected individuals.
Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/prevention & control , Acyclovir/analogs & derivatives , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , HIV Infections/complications , Herpes Genitalis/drug therapy , Herpes Genitalis/prevention & control , Simplexvirus , Valine/analogs & derivatives , Valine/therapeutic use , Acyclovir/administration & dosage , Adult , Aged , Antiviral Agents/administration & dosage , Confidence Intervals , Double-Blind Method , Drug Administration Schedule , Female , Humans , Male , Middle Aged , Recurrence , Treatment Outcome , Valacyclovir , Valine/administration & dosageABSTRACT
The endonasal endoscopic approach to the paranasal sinuses is no longer exclusively practised by a small number of dedicated super-specialists and has gained widespread acceptance in the UK. We have audited the practice of the Consultant members of the BAO-HNS via a confidential postal questionnaire with regards to the consent of their patients prior to surgery, and to the complications they have experienced. The overall rate of complications following endoscopic sinus surgery (ESS) was 0.69%, with the incidence of major complications 0.25% and of minor complications 0.44%. Wide variations in the practice of informed consent were found to exist, and this is discussed with reference to a suggested template for preoperative discussion with the patient.
