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Effectiveness of acyclovir prophylaxis against varicella zoster virus disease after allogeneic hematopoietic cell transplantation: A systematic review and meta‐analysis
Author(s) -
WadaShimosato Yuko,
Tanoshima Reo,
Hiratoko Kanako,
Takeuchi Masanobu,
Tsujimoto ShinIchi,
Shiba Norio,
Ito Shinya,
Yamanaka Takeharu,
Ito Shuichi
Publication year - 2019
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.13061
Subject(s) - medicine , varicella zoster virus , discontinuation , aciclovir , relative risk , adverse effect , transplantation , incidence (geometry) , meta analysis , hematopoietic stem cell transplantation , antibiotic prophylaxis , randomized controlled trial , immunology , confidence interval , virus , viral disease , herpesviridae , antibiotics , physics , microbiology and biotechnology , optics , biology
Abstract Background Varicella zoster virus (VZV) disease is a common complication after hematopoietic cell transplantation (HCT). The mortality rate for disseminated VZV infection is 34%. Acyclovir has been used for the prophylaxis of VZV disease after HCT, but the effectiveness of prophylaxis is controversial. We conducted a meta‐analysis of the incidence of VZV disease within the first 1 year after acyclovir prophylaxis had been discontinued and assessed the risk of VZV disease during acyclovir prophylaxis. Methods Medline, EMBASE plus EMBASE classics, and the Cochrane Central Register of Controlled Trials were used for a systematic search. The inclusion criteria were both randomized controlled trials and cohort studies that described the effectiveness of acyclovir as prophylaxis against VZV disease after allogeneic HCT. Results We included seven studies involving a total of 2265 patients. No mortality by VZV was identified. Acyclovir prophylaxis significantly reduced the rate of VZV infection within the first 1 year after discontinuation (risk ratio: 0.38, 95% confidence interval (CI): 0.29‐0.51). The risk of VZV disease during acyclovir prophylaxis was also reduced (risk ratio: 0.17, 95% CI: 0.12‐0.24). Both short–term and long–term prophylaxis reduced the incidence of VZV infection (RR: 0.51, 95% CI: 0.30‐0.86 vs RR: 0.34, 95% CI: 0.22‐0.54). Low–dose acyclovir (<400 mg/d) is sufficient to reduce the risk of VZV disease. Conclusion This study showed that acyclovir prophylaxis reduced VZV infection after HCT with no fatal cases and acyclovir prophylaxis is beneficial. No significant adverse effects occurred and no delayed VZV disease was identified.