Etiopathogenetic substantiation of the algorithm for specific antiviral therapy of chronic inflammatory forms of oropharyngeal pathology associated with herpesvirus infection

Abstract

Due to the proven significant role of herpesvirus infection in the occurrence and recurrence of various forms of oropharyngeal pathology, the present study aimed to substantiate, taking into account data on the etiology and pathogenesis of herpetic infection, formulate, and test an algorithm for the use of specific antiviral drugs for the treatment of chronic forms of oropharyngeal inflammation associated with herpesvirus infection. Methods. The study included 170 patients with chronic inflammatory forms of oropharyngeal pathology, who underwent a prior clinical and virological examination with real-time PCR and cultural diagnostics. For the cultural diagnostics, a transferable VERO cell culture was used as a biological model, into which the studied material was introduced. Before and after the treatment, the condition of the infected cell monolayer of the biological model was assessed to identify the cytopathic effect of the herpesvirus. The patients were divided into 3 groups: main, comparison, and control. The main group (patients with chronic inflammatory forms of oropharyngeal pathology associated with herpesvirus infection) received a specific antiviral therapy; the comparison group (patients with chronic inflammatory forms of oropharyngeal pathology associated with herpesvirus infection) received a standard treatment. The control group (patients with chronic inflammatory forms of oropharyngeal pathology without herpesvirus infection) also received a standard treatment. Based on results of clinical and virological examinations before and after the course of treatment, the efficacy of the specific antiviral therapy was evaluated in patients with chronic forms of oropharyngeal inflammation associated with herpesvirus infection. Results. In the group of patients after specific antiviral therapy, the clinical efficacy of the treatment was significantly higher compared to the standard therapy group: the severity of throat soreness and oropharyngeal inflammation significantly decreased, there were no relapses of the disease, and the quality of life improved. Also, a correlation was found between the results of virological examination (significant decrease in the number of various types of herpesviruses on the oropharyngeal mucosa and less pronounced or absent signs of cytopathic action of viruses), and changes in the clinical picture of the disease (normalization of the oropharynx; reduced severity of throat soreness). Conclusion. The results of the study justified isolation of an independent nosological form of “viral tonsillopharyngitis”. For this condition, an algorithm was developed and successfully tested for the treatment of chronic inflammatory oropharyngeal pathology associated with herpesvirus infection. This algorithm includes the administration of valacyclovir according to a new schedule: 500 mg twice a day for 10 days. This treatment regimen provided a high clinical efficacy.