Value of long-term administration of acyclovir and similar agents for protecting against AIDS-related lymphoma: Case-control and historical cohort studies

Acyclovir or similar agents with activity against Epstein-Barr virus (EBV) theoretically may prevent non-Hodgkin's lymphoma (NHL) in AIDS. A case-control study of 29 patients with AIDS-related NHL and 58 matched control subjects assessed the frequency with which daily acyclovir (greater than or equal to 800 mg/d) or similar agents were used for greater than or equal to 1 year. In a historical cohort of 304 patients with AIDS for greater than or equal to 2 years, the prevalence of NHL was assessed among 3 groups of patients: those who received long-term treatment with high-dose acyclovir (or similar agents) or low-dose or intermittent acyclovir; those treated with ganciclovir/foscarnet for <1 year; and those who had not previously been treated with acyclovir, ganciclovir, or foscarnet, In the case-control study, 22 patients (72.4%) with NHL never received acyclovir or similar drugs versus 19 control subjects (32.8%; P = .002); 2 patients (6.9%) with NHL received acyclovir (greater than or equal to 800 mg/d) for greater than or equal to 1 year versus 27 (46.6%) of control subjects (P = .0001), In the cohort study, 6 (6.8%) of 88 patients who received acyclovir (greater than or equal to 800 mg/d) for greater than or equal to 1 year developed NHL versus 15 (15.5%) of 97 patients who received intermittent or lower-dose acyclovir and 30 (25.2%) of 119 patients who never received these agents (P = .002), Long-term administration (>1 year) of high-dose acyclovir or similar agents with anti-EBV activity may prevent NHL in patients with AIDS. A prospective, randomized study is warranted to confirm these results.