Question 2: Antiviral treatment of varicella in adult or immunocompromised patients

A search of the English and French Literature from 1980 or 1997 identified 20 papers (excluding isolated cases reports) on the treatment of adult varicella. Most of these studies are ancient with an insufficient methodology. Only 7 are randomized and only 6, open labeled or retrospective, include more than 10 patients. Three studies compare acyclovir versus placebo in 316 immunocompetent adults with uncomplicated varicella, Only one has a correct methodology. Acyclovir showed a benefit on all studied parameters only for patients treated in the 24 h following eruption. One study randomised sorivudine versus placebo in 186 patients. A reduction of duration of fever and hospitalization was noted in patients receiving sovirudine. However, frequency or duration of symptoms was only decreased in patients treated in the 24 h following eruption. Two studies evaluating open label acyclovir displayed a benefit only for early therapy. For the treatment of complicated varicella in immunocompetent patients, only open label studies are available. Among 56 patients receiving early acyclovir, only 2 deaths are observed. Papers on immunodepressed patients often associated varicella and tester. The two randomized studies include only 14 varicella among 66 patients. The largest retrospective study includes 57 varicella among 113 patients, Treatments used include acyclovir, sorivudine, adenine arabinoside or varicella tester immune globulins. Only 12 deaths are observed among 113 treated varicella. Analyses of experts recommendations shows a consensus for treating complicated varicella and conflicting opinions for the treatment of uncomplicated varicella in the immunocompetent adult. The treatment of uncomplicated varicella in the immunocompetent adult shows a modest benefit. Treatment of complicated varicella or of the immunocompromised host is highly beneficial, however, comparative studies of a sufficient power are needed to evaluate the efficacy of treatment on varicella mortality.