Six patients with severe, recalcitrant, juvenile-onset recurrent respiratory papillomatosis were treated with 7 independent trials of acyclovir. In 2 trials, patients received acyclovir in place of interferon-α; the remaining 5 trials were in patients not otherwise receiving chemotherapy. Quantitative analysis of overall disease extent, laryngeal involvement, and degree of glottic obstruction for the 6 months prior to acyclovir administration and during acyclovir administration demonstrated a statistically significant decrease in all parameters evaluated in those patients who were otherwise unmedicated. The 2 patients who discontinued interferon-α immediately prior to beginning acyclovir demonstrated worsening disease, consistent with the well-recognized rebound phenomenon associated with stopping interferon. This study suggests that acyclovir decreases the extent of respiratory papillomatosis in patients with recalcitrant disease. The beneficial effect of acyclovir appears to be insufficient to counteract the rebound of disease when interferon is stopped abruptly.
QuickCAFoucarEDehnerLP. Frequency and significance of epithelial atypia in laryngeal papillomatosis. Laryngoscope1979; 89: 550–60.
2.
SmithEMJohnsonSRCripeTPPignatariSTurekL. Perinatal vertical transmission of human papillomavirus and subsequent development of respiratory tract papillomatosis. Ann Otol Rhinol Laryngol1991; 100: 479–83.
3.
KashimaHKShahFLylesA. A comparison of risk factors in juvenile-onset and adult-onset recurrent respiratory papillomatosis. Laryngoscope1992; 102: 9–13.
BryanRLBevanISCrockerJYoungLS. Detection of HPV 6 and 11 in tumours of the upper respiratory tract using the polymerase chain reaction. Clin Otolaryngol1990; 15: 177–80.
6.
DugganMALimMGillMJInoueM. HPV DNA typing of adult-onset respiratory papillomatosis. Laryngoscope1990; 100: 639–42.
7.
MountsPShahKVKashimaH. Viral etiology of juvenile and adult onset squamous papilloma of the larynx. Proc Natl Acad Sci USA1982; 79: 5425–9.
8.
StrongMSVaughanCWHealyGBCooperbandSRClementeMACP. Recurrent respiratory papillomatosis. Management with the CO2 laser. Ann Otol Rhinol Laryngol1976; 85: 508–16.
9.
WetmoreSJKeyJMSuenJY. Complications of laser surgery for laryngeal papillomatosis. Laryngoscope1985; 95: 798–801.
10.
SingletonGTAdkinsWY. Cryosurgical treatment of juvenile laryngeal papillomatosis. An eight year experience. Ann Otol Rhinol Laryngol1972; 81: 784–90.
11.
FrootkoNJRogersJH. The treatment of juvenile multiple laryngeal papillomatosis by suction diathermy. J Laryngol Otol1979; 93: 373–81.
12.
BirckHGManhartHE. Ultrasound for juvenile laryngeal papillomatosis. A preliminary report of five cases. Arch Otolaryngol1963; 77: 603–8.
13.
HollingsworthJBKohlmoosHWMcNaughtRC. Treatment of juvenile papilloma of the larynx with resin of podophyllum. A preliminary report. Arch Otolaryngol1950; 52: 82–7.
14.
HolingerPHShipkowitzNLHolperJCWorlandMC. Studies of etiology of laryngeal papilloma and an autogenous laryngeal papilloma vaccine. Acta Otolaryngol (Stockh)1968; 65: 63–9.
15.
HolingerPHJohnstonKCAnisonGC. Papilloma of the larynx: A review of 109 cases with a preliminary report of aureomycin therapy. Ann Otol Rhinol Laryngol1950; 59: 547–64.
16.
SakuraiSTakahasiMNakajimaYIshizakaT. Juvenile papilloma of the larynx treated by bleomycin. Keio J Med1975; 24: 11–7.
GoepfertHSessionsRBGuttermanJUCangirADichtelWJSulekM. Leukocyte interferon in patients with juvenile laryngeal papillomatosis. Ann Otol Rhinol Laryngol1982; 91: 431–6.
20.
McCabeBFClarkKF. Interferon and laryngeal papillomatosis. The Iowa experience. Ann Otol Rhinol Laryngol1983; 92: 2–7.
21.
LundquistP-GHaglundSCarlsööBStranderHLundgrenE. Interferon therapy in juvenile laryngeal papillomatosis. Otolaryngol Head Neck Surg1984; 92: 386–91.
22.
LeventhalBGKashimaHKMountsP. Long-term response of recurrent respiratory papillomatosis to treatment with lymphoblastoid interferon alfa-n1. N Engl J Med1991; 325: 613–7.
23.
CrockettDMMcCabeBFShiveCJ. Complications of laser surgery for recurrent respiratory papillomatosis. Ann Otol Rhinol Laryngol1987; 96: 639–44.
AguadoDLPineroBPBetancorLMendezABenalesEC. Acyclovir in the treatment of laryngeal papillomatosis. Int J Pediatr Otorhinolaryngol1991; 21: 269–74.
26.
KashimaHLeventhalBMountsP, Papilloma Study Group. Scoring system to assess severity and course in recurrent respiratory papillomatosis. In: HowleyPMBrokerTR, eds. Papillomaviruses: molecular and clinical aspects. New York, NY: Alan R Liss, 1985: 125–35.
27.
LuskRPMcCabeBFMixonJH. Three-year experience of treating recurrent respiratory papilloma with interferon. Ann Otol Rhinol Laryngol1987; 96: 158–62.
28.
ElionGB. Mechanism of action and selectivity of acyclovir. Am J Med1982; 73(suppl 1A): 7–13.
29.
O'BrienWJCoeECTaylorJL. Nucleoside metabolism in herpes simplex virus-infected cells following treatment with interferon and acyclovir, a possible mechanism of synergistic antiviral activity. Antimicrob Agents Chemother1990; 34: 1178–82.
