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Management of acyclovir-resistant herpes simplex virus.
1Department of Dermatology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030, USA.
Dermatologic Clinics
|May 22, 2003
Summary
Immunocompromised patients often experience severe herpes simplex virus (HSV) infections. This guide outlines treatment protocols for both susceptible and drug-resistant HSV, emphasizing alternative therapies when standard treatments fail.
Area of Science:
- Infectious Diseases
- Virology
- Dermatology
Background:
- Immunocompetent individuals typically control herpes simplex virus (HSV) effectively, with mild, short-lived recurrences.
- Immunocompromised patients are susceptible to severe, frequent HSV reactivations, potentially leading to life-threatening complications like encephalitis.
- Antiviral drug resistance is a significant challenge in managing HSV infections in immunocompromised populations.
Purpose of the Study:
- To provide a treatment protocol for managing herpes simplex virus (HSV) infections in immunocompromised patients.
- To address challenges posed by antiviral drug resistance in HSV treatment.
- To guide physicians in selecting appropriate therapeutic regimens for both susceptible and refractory HSV disease.
Main Methods:
- Initiation of standard oral acyclovir (ACV) therapy (200 mg, five times daily).
- Dose escalation of oral ACV to 800 mg, five times daily, if initial response is poor.
- Consideration of alternative treatments including intravenous ACV, triflurated (TFT), foscarnet, cidofovir, and vidarabine for refractory cases.
- Repeat cultures for pathogens and ACV susceptibility testing when standard therapies fail.
- Specific protocols for recurrent lesions based on location and previous treatment response.
Main Results:
- A stepwise approach to HSV treatment is proposed, starting with oral acyclovir and escalating to alternative agents based on patient response.
- Identifies foscarnet, cidofovir, and vidarabine as options for antiviral-resistant HSV infections.
- Highlights the importance of susceptibility testing and pathogen identification in refractory cases.
- Differentiates treatment strategies for recurrent HSV lesions based on location.
Conclusions:
- Physicians must develop comprehensive treatment regimens to manage both susceptible and refractory herpes simplex virus (HSV) disease in immunocompromised patients.
- The proposed protocol offers a structured approach to HSV management, guiding the use of various antiviral agents.
- Further research into novel drugs is crucial for improving outcomes in patients with documented HSV resistance.