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acyclovir as a preventative for AID related lymphoma
Mar 2, 2001

In one of your recent lymphoma Q&A's you said that there is no evidence that acyclovir will help in treating Hodgkins Disease. I've recently read a study done at the University of Toronto (published this year) which found a significantly lower incidence of AIDS related lymphoma in those who had a year or more of prior treatment with acyclovir, versus those who had not taken acyclovir. I've also read that in organ transplant patients who are artificially immunosuppressed, acyclovir with interferon alpha is often used effectively to treat certain types of lymphoma. Since many reports are indicating that AIDS related lymphomas continue to occur at rather high rates despite HAART, I'm naturally interested in doing anything I can to improve my odds. I've been on HAART for over two years, CD4s around 240 (up from 50). At my CD4 nadir, I had severe outbreaks of genital herpes, and have a history of shingles six years before my AIDS diagnosis. I realize the verdict may not be in on the value of acyclovir, but if this drug is relatively non-toxic, is there any reason, in your opinion, why patients shouldn't avail themselves of its potential benefits as a lymphoma preventative, and to control a possible HIV co-factor? Thanks.

Response from Dr. Dezube

You ask an excellent question. Most of what you say is precisely on target. The University of Toronto study (Clinical Infectious Diseases 2000;30:757) did indeed show that long-term administration of high-dose acyclovir may prevent non-Hodgkin's lymphoma. I also agree with you that acyclovir is relatively non-toxic. HOWEVER, before you rush to your local pharmacy, you need to understand that this was a case-control and a historical cohort study. Such studies are NOT as statistically sound as a prospective, randomized study. Indeed it is not that uncommon that the results of preliminary studies are overturned by randomized studies. The best you can conclude from the Toronto study is that further study of acyclovir is needed. I personally would NOT recommend long terms acyclovir to you, nor do I recommend it for my HIV-infected patients.

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