Nucleoside Antiviral Therapy for Herpes Zoster: A Literature Review
Authors
Nisrina Huurul Ain , Lalu Mas’ud Rahmatullah , Widi Gustita Utari , Imasayu Nuralyza , Baiq Rani Salsabiella , Reivirly Khairadaty Maghfirahandini , Siti Rahmatul Aini , Nurhidayati NurhidayatiDOI:
10.29303/jbt.v25i3.10006Published:
2025-08-26Issue:
Vol. 25 No. 3 (2025): Juli-SeptemberKeywords:
Aacyclovir, Brivudine, Herpes zoster, Nucleoside analogs, Varicella-zoster virusArticles
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Abstract
Herpes zoster is a viral skin infection caused by the reactivation of the varicella-zoster virus, which remains latent in the dorsal root ganglia of the spinal cord and the cranial sensory ganglia. One of the most widely used classes of antiviral agents in the treatment of herpes zoster is nucleoside analogs. This study aims to review the use of nucleoside analogs in the management of herpes zoster. The method employed was a literature review of relevant research articles. The findings indicate that nucleoside analogs commonly used in herpes zoster therapy include acyclovir, valacyclovir, famciclovir, and brivudine. These agents are administered in various doses, routes, and therapeutic purposes, such as alleviating acute symptoms, accelerating skin lesion healing, preventing postherpetic neuralgia, and serving as prophylactic therapy in special conditions such as cancer or organ transplantation. Overall, the use of nucleoside analogs has proven effective in inhibiting varicella-zoster virus replication, reducing symptom intensity, and minimizing the risk of complications.
References
Andrei, G., & Snoeck, R. (2021). Advances and perspectives in the management of varicella-zoster virus infections. Molecules, 26, 1–34. https://doi.org/10.3390/molecules26041132
Cohen, E. J., & Jeng, B. H. (2021). Herpes Zoster: A Brief Definitive Review. Cornea, 40(8), 943–949. https://doi.org/10.1097/ICO.0000000000002754
Crouch, A., Le, M., Rogers, C., Shao, S., & Kotton, C. (2021). Evaluation of low dose famciclovir as herpes simplex virus and varicella zoster virus prophylaxis in cytomegalovirus low-risk solid organ transplant recipients. Transplant Infectious Disease, 23(5), 1–7. https://doi.org/10.1111/tid.13711
De Clercq, E. (2023). The development of BVDU: An odyssey. Antiviral Chemistry and Chemotherapy, 31, 1–8. https://doi.org/10.1177/20402066231152971
Devi, M., Ismunandar, H., Wintoko, R., Hadibrata, E., & Djausal, A. N. (2022). Penegakan Diagnosis dan Penatalaksanaan Herpes Zoster. Medical Profession Journal of Lampung, 12(1), 40–48. https://doi.org/10.53089/medula.v12i1.330
Fitriani, F., Kariosentono, H., Prasetyorini, B. E., Oktriana, P., & Amelinda, N. (2021). Tata Laksana Herpes Zoster. Medicinus, 34(3), 50–60. https://doi.org/10.56951/medicinus.v34i3.82
Gross, G. E., Eisert, L., Doerr, H. W., Fickenscher, H., Knuf, M., Maier, P., Maschke, M., Müller, R., Pleyer, U., Schäfer, M., Sunderkötter, C., Werner, R. N., Wutzler, P., & Nast, A. (2020). S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia. JDDG - Journal of the German Society of Dermatology, 18(1), 55–78. https://doi.org/10.1111/ddg.14013
Junior, H. P., Oliveira, M. F. B. de, Gambero, S., & Amazonas, R. B. (2018). Randomized clinical trial of famciclovir or acyclovir for the treatment of herpes zoster in adults. International Journal of Infectious Diseases, 72, 11–15. https://doi.org/10.1016/j.ijid.2018.04.4324
Kato, K., Murakami, R., Shiroto, H., Nagawa, D., Narita-Kinjo, I., Fujita, T., Shimada, M., & Tomita, H. (2023). Valacyclovir-associated acute kidney injury and encephalopathy in an elderly woman with normal kidney function: a case report. CEN Case Reports, 12(2), 221–225. https://doi.org/10.1007/s13730-022-00748-5
Kausar, S., Said Khan, F., Rehman, M. I. M. U., Akram, M., Riaz, M., Rasool, G., Khan, A. H., Saleem, I., Shamim, S., & Malik, A. (2021). A review: Mechanism of action of antiviral drugs. International Journal of Immunopathology and Pharmacology, 35, 1–12. https://doi.org/10.1177/20587384211002621
Kennedy, P. G. E., & Gershon, A. A. (2018). Clinical Features of Varicella-Zoster Virus Infection. Viruses, 10(11), 1–11. https://doi.org/10.3390/v10110609
Kim, S. H. (2023). Current scenario and future applicability of antivirals against herpes zoster. Korean Journal of Pain, 36(1), 4–10. https://doi.org/10.3344/kjp.22391
Koshy, E., Mengting, L., Kumar, H., & Jianbo, W. (2018). Epidemiology, treatment and prevention of herpes zoster: A comprehensive review. Indian Journal of Dermatology, Venereology and Leprology, 84(3), 251–262. https://doi.org/10.4103/ijdvl.IJDVL
Lio, J. (2023). An Overview of Brivudine Uses and its Mechanism of Action and Future Prospects. Pharmacoepidemiology and Drug Safety, 12(4), 1–2. https://doi.org/10.35248/2167-1052.23.12.323
Liu, Y., Xiao, S., Li, J., Long, X., Zhang, Y., & Li, X. (2023). A Network Meta-Analysis of Randomized Clinical Trials to Assess the Efficacy and Safety of Antiviral Agents for Immunocompetent Patients with Herpes Zoster-Associated Pain. Pain Physician, 26(4), 337–346. https://doi.org/10.36076/ppj.2023.26.337
Majewska, A., & Mlynarczyk-Bonikowska, B. (2022). 40 Years after the Registration of Acyclovir: Do We Need New Anti-Herpetic Drugs? International Journal of Molecular Sciences, 23(7), 1–33. https://doi.org/10.3390/ijms23073431
Mostofa, M. K., Sen, K. G., Sarkar, S. K., Uddin, M., Begum, K., Ahmed, K., Miah, M., Salsma, U., & MS, I. (2018). Efficacy and Safety of Valacyclovir overAcyclovir-A Study of 50 Herpes Zoster Patients in FMCH, Faridpur. Faridpur Medical College Journal, 13(2), 74–77. https://doi.org/10.3329/fmcj.v13i2.43642
Motswaledi, M. (2018). Herpes zoster (Shingles). South African Family Practice, 60(4), 28–30. https://doi.org/10.4102/safp.v60i4.4898
Oka, T., Hishizawa, M., Yamashita, K., Shiraki, K., & Takaori-Kondo, A. (2021). Successful treatment with famciclovir for varicella zoster virus infection resistant to acyclovir. Journal of Infection and Chemotherapy, 27(5), 755–758. https://doi.org/10.1016/j.jiac.2020.12.013
Onaka, T., Shiraki, K., & Yonezawa, A. (2021). Improvement of acyclovir-resistant herpes zoster infection by amenamevir. Journal of Dermatology, 48(9), 1–2. https://doi.org/10.1111/1346-8138.16027
Patil, A., Goldust, M., & Wollina, U. (2022). Herpes zoster: A Review of Clinical Manifestations and Management. Viruses, 14(2), 1–13. https://doi.org/10.3390/v14020192
Purwoko, M. I. H., & Darmawan, H. (2020). Herpes Zoster: Clinical Manifestation, Treatment, and Prevention. Bioscientia Medicina, 4(3), 34–44. https://doi.org/10.32539/bsm.v4i3.129
Rajbhandari, L., Shukla, P., Jagdish, B., Mandalla, A., Li, Q., Ali, M. A., Lee, H., Lee, G., Sadaoka, T., Cohen, J. I., & Venkatesan, A. (2021). Nectin-1 Is an Entry Mediator for Varicella-Zoster Virus Infection of Human Neurons. Journal of Virology, 95(22), 1–12. https://doi.org/10.1128/jvi.01227-21
Shiraki, K., Takemoto, M., & Daikoku, T. (2021). Emergence of varicella-zoster virus resistance to acyclovir: epidemiology, prevention, and treatment. Expert Review of Anti-Infective Therapy, 19(11), 1–11. https://doi.org/10.1080/14787210.2021.1917992
Tayyar, R., & Ho, D. (2023). Herpes Simplex Virus and Varicella Zoster Virus Infections in Cancer Patients. Viruses, 15(2), 1–20. https://doi.org/10.3390/v15020439
Tommasi, C., & Breuer, J. (2022). The Biology of Varicella-Zoster Virus Replication in the Skin. Viruses, 14, 1–14. https://doi.org/10.3390/v14050982
Yeh, C. H., Chang, K. S., Huang, S. S., Tsay, S. L., Tsai, J. M., & Wang, Y. J. (2022). Comparing Prodrugs with Acyclovir for Treating Postherpetic Neuralgia among Herpes Zoster Patients: A Systematic Review and Meta-Analysis. Healthcare (Switzerland), 10(7). https://doi.org/10.3390/healthcare10071181
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Copyright (c) 2025 Nisrina Huurul Ain, Lalu Mas’ud Rahmatullah, Widi Gustita Utari, Imasayu Nuralyza, Baiq Rani Salsabiella, Reivirly Khairadaty Maghfirahandini, Siti Rahmatul Aini, Nurhidayati Nurhidayati

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