A question about aciclovir

[Finnboy]

I've had quite a few outbursts of labial cold sores recently. Nothing major and nothing new - the individual blisters are barely the size of a pinhead and heal within a day or two – but they have increased in frequency.

Because the occasional inconvenience has been so small, I have never really made any effort to control them; but doctor dearest has suggested - and I am inclined to agree with her - that I'd probably be better off if I added a supply of aciclovir to the medicinal armoury (at least until I can resolve the domestic stress that is almost certainly triggering the outbursts).

Cost isn't an issue, but she has given me the option of either a high dose episodic prescription (i.e. when I feel an outbreak coming on, as I can always tell at least a week ahead of blistering) or a lower dose continuous prophylactic prescription.

I'd be interested to hear what experiences anyone else has with aciclovir – particularly which regimen you have found most convenient / effective for you.

[keyite]

I can always tell at least a week ahead of blistering

Wow, you're lucky. From start of tingling to actual sore is typically a day or less in my case. I have tried both approaches and - for this reason - have found a continuous suppressive regime the most effective. I was a little worried about the impact on the liver of taking acyclovir long-term but my HIV consultant recently assured me that the impact is very light. In your case it probably matters less which approach you go for, so if I were you I'd choose the one you're most comfortable with.

[Finnboy]

Thanking you kindly 

I take it the lower dose suppressive regime actually works for you then.

To be honest, I am not uncomfortable with either - but if I don't hear any nasties about the suppressive regime, then that would be what I am inclined to try; because it slots nicely into my existing pill taking routine

Your consultant is right. It is valaciclovir (the pro-drug version of aciclovir) that has more associativity with the nastier problems (such as bleeding in the kidneys).

[keyite]

You're very welcome! Yup, I was on 2 x 400mg / day and it worked perfectly. I stopped it after a few months on HAART - partly because I felt I needed to reduce the pill burden (mostly a psychological issue, I'm sure) - but also because I wanted to see if a drug interaction was causing the tinnitus I am experiencing on Sustiva/Truvada (it doesn't look that's the cause). Smaller outbreaks are back so I will probably start the acyclovir regimen again soon.

Good luck

[Ann]

Hi Finn,

I also take acyclovir daily- 400mgs once a day. Some people take 400mgs twice a day, but I normally do ok on the low dose. Sometimes when I'm under a lot of stress I'll feel a breakthrough blister coming on and when that happens, I have a supply of 200mg tabs which I supplement my normal dose with. Doing this nips the blister in the bud before it even becomes visible.

I dithered for a long time before finally taking the acyclovir daily. I first went the "as needed" route, but it only lessened the severity of the outbreaks, it didn't stop them. I will continue taking it daily as I figure that it gives my body one less virus to worry about.

I also just came across a very interesting article:  Herpes drug has direct anti-HIV effect, could offer cheap addition to antiretroviral therapy for developing world

Ann

[Finnboy]

Thanks Ann, that is really helpful. The business about just reducing the severity was what was one of the possibilities I was thinking about.

That's an interesting article. There have been conflicting reports about the antiretroviral effect for a while, so nice that someone has finally nailed that mystery