EUROMEDICA  Hanover 23-24  Mai 2011	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover

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High morbidity with herpesviral infections (HVI) represents one of the most important problems for healthcare worldwide. Herpesviridae (HV) are pantropic, and can target all organs and tissues in host, thus, resulting in latent, acute, chronic, and slow infections. Altogether, it defines HVI as a systemic disease which should be considered as an interdisciplinary medical problem.

Recurrent genital herpes (RGH) is detected in youngsters and middle-age adults, where 76% of cases were due to HSV-2, whereas HSV-1 was found in 24% (St. Petersburg, Russia). Moreover, RGH was shown as mono-infection in 27% of all examined patients. Patients with at least six relapses of RGH per year were found to have reduced production of endogenous IFN-α and IFN-γ, which was accompanied with lowered activity of CD16⁺ NK cells as well as CTL cytotoxicity, decreased absolute numbers of both total T cells and СD4⁺ T cells (and decreased functional activity). In addition, it also revealed decreased numbers of neutrophils and their activity, but increased content of immune complexes. In women with RGH they were shown to have intestinal and vaginal dysbiosis. These immune disturbances were found both during relapse and remission.

Modern antivirals which are used to quickly control relapses of RGH, however, do not prevent new recurrences, nor do they reduce its frequency. Moreover, long-term antiviral therapy is not always applicable. Thus, all these issues mentioned above predetermined that in order to treat RGH a complex systemic therapeutic approach should be used. Altogether, it underlies a reason that in 1991 we proposed a four-stage complex therapy. Since then more than 800 RGH patients were treated by using this method.

Stage 1 – treatment of acute phase. Antivirals with different mode of action should be combined with compounds having immunobiological effect: Valacyclovir or Famciclovir, recombinant Interferons (IFN) or IFN inducers (Isoprinosin, Kagocel, Cycloferon the having identical mechanism of action with Imiqumod), immunomodulators, systemic enzyme therapy (SET). Wobenzym (Mucos Pharma, Gerrmany) has anti-inflammatory, anti-edemic, fibrinolytic, imunomodulatory, secondary analgetic, antiviral effect, and immunoregulatory effect: stimulation of IFN production, increased NK cell activity, normalized Th1/Th2 balance, decrease of pathology-associated pro-inflammatory fibrosis-inducing cytokines. Usage of medicines with different mode of action provides with synergistic and additive effect.

Stage 2 – treatment of early remission (d8-15 of relapse). Main goal – to reach clinical and immunological remission, to prepare a patient for vaccine therapy. For this immunomodulators, phytogenic adaptogens and SET should be used.

Stage 3 – specific prophylaxis of herpes relapses is reached by using inactivated divalent vaccine together with IFN inducers. All medicines should be used until clinical and immunologic remission is reached (in 34 weeks). Goal of vaccination – to restimulate cellular immunity, perform its immunocorrection as well as specific desensibilization. Vaccine is injected by intradermal route, according to allergometric scale that allows to determine max. lowest working dosage of anti-herpetic vaccine. By using vaccine in this way increased amounts of CD4⁺ and CD8⁺ T cells as well as CD16⁺ NK cells are achieved. Such positive changes are important as all these immune cells are involved in developing protective immunity during RGH. Moreover, vaccine therapy results in significant increase of blood serum IFN-γ in parallel with simultaneous decrease of IL-4 suggesting Th1-skewed polarization of immune reactions.

Stage 4 – dispensary observation and rehabilitation of patients with RGH. Proactive follow-up of patients together with clinical and laboratory monitoring should be prioritized, sites of chronic infection should be cured; immunorehabilitation must be carried out. Pathogenetic therapy based on patient’s status should be performed (SET, prebiotics etc.). Patient should be consulted by psychotherapist, immunologist, and neurologist. Course of vaccine therapy may be repeated to provide with further prophylaxis of RGH.

Thus, basing on the proposed multi-stage complex therapy period of remission for RGH was increased at least three-fold, and it was accompanied with improved quality of patient’s life.

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