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A prospective study of the effects of acyclovir treatment on the HSV-2 lymphoproliferative response of persons with frequently recurring HSV-2 genital infections.

In a randomized double-blinded fashion, herpes simplex virus type 2 specific lymphocyte proliferation (HSV-2-LP) was studied in patients with frequently recurring genital HSV-2 who were administered daily suppressive oral acyclovir (S-ACV) or placebo and acyclovir for 5 d (PLC/ACV) with recurrences. The pretreatment HSV-2-LP of subjects was low compared with that of controls with infrequently recurring genital HSV-2 (54,000 vs. 110,000 cpm). The HSV-2-LP increased with both S-ACV and PLC/ACV (101,000 and 94,000 cpm, respectively). After treatment was stopped, the HSV-2-LP decreased in both groups (59,000 cpm). Similar data were seen in a subpopulation given a second year of S-ACV. HSV recurrences were reduced in the S-ACV but not in the PLC/ACV group. These data suggest that a low HSV-2-LP in untreated patients is associated with frequent recurrences of genital HSV; a reduction of viral antigens by suppression with ACV or early treatment of HSV recurrences augments the HSV-2-LP response; and the recurrence pattern is not modulated by the HSV-2-LP response.