Overcoming Resistance: A Comprehensive Review and Treatment Approach for Acyclovir-Resistant Herpes Simplex Keratitis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Virology

Background:

• Herpes simplex keratitis (HSK) is a significant cause of vision impairment due to HSV infections.
• Acyclovir (ACV) is the primary treatment, but increasing resistance poses a clinical challenge.

Purpose of the Study:

• To comprehensively review the treatment strategies for acyclovir (ACV)-resistant herpes simplex keratitis (HSK).
• To provide guidance for clinicians managing this challenging condition.

Main Methods:

• A narrative review was conducted using comprehensive literature searches of Web of Science, PubMed, and Scopus.
• The review synthesizes information on the diagnosis and alternative treatments for ACV-resistant HSK.

Main Results:

• Alternative treatments include increased ACV doses, oral valacyclovir (VACV), topical foscarnet (FOS), ganciclovir (GCV), trifluridine, cidofovir, and lesion debridement.
• Emerging therapies such as helicase primase inhibitors and BX795 are also discussed.
• Diagnosis of cytomegalovirus is crucial in ACV-resistant cases.

Conclusions:

• Rising ACV resistance in HSK necessitates exploring alternative and emerging treatment options.
• Effective management requires a thorough understanding of diagnostic approaches and therapeutic strategies.
• Clinicians should consider a range of treatments, from established antivirals to novel agents, for ACV-resistant HSK.