Discussion
herpes, COPD
INFILTRATE, HERPES, RECRUITMENT, ORAL HAIRY LEUKOPLAKIA, COPD, IDIOPATHIC PULMONARY FIBROSIS
In this randomized double-blind placebo-controlled trial of patients with moderate to severe COPD, valaciclovir was shown to be safe and effective for the suppression of EBV. We used valaciclovir at a dose of 1 g tid on the basis of a previous open-label study of oral hairy leukoplakia by Walling et al.This study was not designed to have adequate power to detect changes in lung function. However, we found a modest 24-mL numerical FEVOur finding that valaciclovir was associated with a reduction in the sputum total cell count may suggest attenuation of the sputum inflammatory cell infiltrate. The absolute neutrophil and macrophage counts were reduced by valaciclovir treatment (by > 50%), contributing to the significant treatment effect on the total cell count. One might hypothesize that persistent EBV shedding contributes to chronic airway immune activation and immune cell recruitment. However, it must be acknowledged that the current study did not demonstrate a definitive between-group difference in sputum cytokine concentrations, and any potential immunomodulatory mechanism of valaciclovir remains to elucidated. The six-fold within-group reduction in IP-10 may warrant further examination. Macrophages release IP-10, which is chemotactic for CD4Our study has some limitations. It is important to consider the spectrum of antiviral activity of valaciclovir. Polosukhin et alBeyond COPD, EBV and other herpes viruses have been targeted therapeutically in idiopathic pulmonary fibrosis. Blackwell et al