Characteristics of Acyclovir-Resistant Herpes Simplex Virus Infection in Hematological Patients

Acyclovir-resistant herpes simplex virus infections pose a significant challenge in immunosuppressed patients. This study aimed to characterize the clinical features, treatment outcomes, and mortality associated with acyclovir-resistant herpes simplex virus infection.

A retrospective analysis was conducted on 18 patients diagnosed with acyclovir-resistant herpes simplex virus. Diagnosis was confirmed via plaque reduction assay. Data on demographics, underlying conditions, oral and systemic manifestations, management, and outcomes were retrieved and analyzed.

The cohort was comprised of 10 women and eight men with a median age of 41.5 years. Acute myeloid leukemia was the most common underlying medical condition (n = 5), and 17 patients had undergone allogeneic hematopoietic cell transplantation. Oral lesions were observed in all 18 cases, primarily on the tongue (n = 12) and lips (n = 11). Acyclovir resistance was detected after a median of 151.5 days (range: 30-1736 days), after which foscarnet became the primary treatment. Despite therapy, 11 patients died after a median survival of 3 months post-diagnosis.

Acyclovir-resistant herpes simplex virus infections are associated with considerable morbidity and mortality in immunocompromised patients. These findings highlight the need for heightened awareness, alternative antiviral therapies, and improved prophylactic strategies to manage these patients more effectively.

Dentists play a key role in detecting acyclovir resistance through persistent oral HSV lesions, emphasizing early recognition, referral, and supportive care.