Prophylactic oral antivirals reduce risk of recurrent ocular herpes simplex

The authors conducted this retrospective study to estimate the incidence of herpes simplex virus (HSV) eye disease in a community-based cohort and investigate the effect of prophylactic oral antiviral therapy on HSV recurrences and outcomes. What they found suggests a more dramatic protective effect of oral antiviral prophylaxis on ocular HSV recurrences than has been described previously.

The investigators reviewed medical records for all Olmsted County, Minn., residents diagnosed with ocular HSV from 1976 through 2007. They identified 394 patients with ocular HSV, yielding an annual incidence of 11.8 per 100,000 people.

Oral antiviral therapy was prescribed to 175 patients. Patients who were not given prophylactic antiviral therapy at the time of recurrence were 9.4 times more likely to have a recurrence of epithelial keratitis, 8.4 times more likely to have a recurrence of stromal keratitis and 34.5 times more likely to have a recurrence of blepharitis or conjunctivitis. Twenty patients experienced adverse outcomes, such as vision loss or need for surgery. Of these 20 patients, 17 (85 percent) were not being treated with oral antiviral medications immediately preceding the adverse event. Patients with adverse outcomes due to ocular HSV were likely to have had an average of four prior episodes of recurrent disease and unlikely to have been undergoing oral antiviral prophylaxis.

The results suggest that oral antiviral prophylaxis should be considered for patients with frequent recurrences of corneal disease. The authors also recommend an evaluation of the possible barriers preventing compliance with antiviral prophylaxis and a reassessment of the cost-effectiveness of long-term oral antiviral therapy.