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Herpes simplex virus (HSV) reactivation can occur with stress and is reported to occur with greater frequency in critically ill patients who receive mechanical ventilation. Is such reactivation simply a marker of severity of illness or a potential contributor to worse outcomes?
Investigators from France randomized 238 mechanically ventilated patients for whom oral swabs were positive for HSV to receive either acyclovir (5 mg/kg thrice daily) or placebo for 14 days. Almost all patients were admitted to the intensive care unit (ICU) for medical reasons, most commonly septic shock and acute respiratory failure. Ventilator-free days and mortality at 60 days were similar in the two groups, as were other clinical outcomes. Adverse events occurred …