Presented by J Gnann. University of Alabama at Birmingham, Birmingham, AL, USA.

The goal of this presentation is to review new data related to antiviral therapy of varicella (chickenpox) and herpes zoster (shingles). We will focus on published data from randomized, controlled clinical trials that have become available since the last IHMF VZV management guidelines were published in 2001. Acyclovir remains the drug of choice for treatment of varicella in immunocompetent and immunocompromised patients. The pharmacokinetic profiles of famciclovir and valacyclovir suggest that these drugs will also be effective for chickenpox, but published data are limited. Treatment approaches for HIV-positive persons and for immunocompetent patients with complicated chickenpox (including pregnant women) remain based on anecdotal data. No large clinical trials addressing varicella therapy have been published since 2001. The efficacy of acyclovir, famciclovir, and valacyclovir for uncomplicated herpes zoster in the immunocompetent host has been well documented. New information demonstrates that famciclovir is effective at doses from 250 mg 3 times daily to 750 mg once daily. Data published since 2001 also indicate that brivudin (BVDU) is an effective antiviral drug for shingles. Brivudin appears to be as effective as acyclovir or famciclovir for herpes zoster, although potentially serious drug interactions have prevented the approval of the drug in some countries. Intravenous acyclovir remains the drug of choice for treatment of herpes zoster in severely immunocompromised persons, although recently published data suggest that oral antiviral drugs (acyclovir and famciclovir) can be safely used in selected patients. Management of complications of herpes zoster (for example, encephalitis) remains based on clinical experience, not prospectively collected data. Revisions to the IHMF Guidelines open to discussion include the addition of brivudin as a recommended treatment for herpes zoster in the normal host.