Acyclovir in Mechanically Ventilated Patients With Pneumonia and HSV-1 in BAL
Status:
Recruiting
Trial end date:
2026-12-01
Target enrollment:
Participant gender:
Summary
Almost 90 out of 100 people carry herpes simplex viruses (HSV). Once a person has been
infected with the herpes viruses, he or she can't get rid of them for the rest of her/his
life. For the most part, the viruses are in a dormant state. Only when the immune system is
weakened, for example in the case of a serious illness or stress, are the viruses
reactivated. They then mainly cause cold sores, which are harmless for healthy people and
usually heal without therapy. However, especially in people with a weakened immune system,
HSV can also cause serious infections, such as meningitis. In almost every second
mechanically ventilated patient in intensive care who has pneumonia, HSV can be detected in
the respiratory tract. This is caused by reactivation of the viruses as a result of the
severe underlying disease and stress during intensive care therapy. Whether treatment of the
herpes viruses (e.g. with acyclovir) is necessary in this situation and helps the patients to
cure has not been clarified, especially as acyclovir can also cause side effects such as a
deterioration in kidney function. Currently, the physicians decide to treat the herpes
viruses in about half of the patients. Several studies have shown that patients for whom the
physician decided to treat the viruses survived more often. However, all of these studies
looked at the course of the disease only retrospectively and thus are subject to many biases
(including physician selection of who receives treatment, missing data). A definitive
conclusion as to whether herpesvirus therapy can be recommended cannot be drawn without doubt
from these studies. Therefore, the investigators would like to investigate in a randomized
controlled trial, i.e. patients are randomly assigned to the experimental (therapy of
herpesviruses) or control group (no therapy of herpesviruses), the effect of therapy with
acyclovir on survival in mechanically ventilated intensive care patients with lower
respiratory tract infection (pneumonia) in whom a large amount of HSV was found in the
respiratory tract. The goal of the study is to provide clarity on whether therapy will help
patients recover.