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Porcine Corneal Tissue Explant to Study the Efficacy of Herpes Simplex Virus-1 Antivirals
Published on: September 20, 2021
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Treatment failure in herpes simplex virus type 1 keratitis
Anna C Randag1, Georges Mgm Verjans2, Lies Remeijer3
1Cornea and External Diseases Department, Rotterdam Eye Hospital, Rotterdam, The Netherlands a.randag@oogziekenhuis.nl.
The British Journal of Ophthalmology
|March 5, 2026
Summary
Aciclovir-resistant herpes simplex virus type 1 (HSV-1) keratitis is rare but challenging. This review explores HSV-1 keratitis pathogenesis, treatment failure causes, and options for resistant cases.
Area of Science:
- Ophthalmology
- Virology
- Infectious Diseases
Background:
- Herpes simplex virus type 1 (HSV-1) commonly causes recurrent ocular infections (keratitis).
- Current treatments involve nucleoside analogues like aciclovir (ACV), often with corticosteroids.
- Treatment failure can stem from adherence issues, incorrect dosing, misdiagnosis, coinfections, or drug resistance.
Purpose of the Study:
- To review the pathogenesis of HSV-1 keratitis.
- To define and explore causes of treatment failure in HSV-1 keratitis.
- To discuss the development and management of aciclovir-resistant (ACVR) HSV-1 keratitis.
Main Methods:
- Literature review of HSV-1 keratitis pathogenesis and treatment.
- Analysis of factors contributing to treatment failure.
- Examination of ACV resistance mechanisms and treatment strategies.
Main Results:
- Aciclovir resistance (ACVR) occurs in approximately 6% of immunocompetent patients with HSV-1 keratitis.
- ACV resistance compromises the effectiveness of standard antiviral therapies.
- Identifying causes of treatment failure is crucial for effective management.
Conclusions:
- Understanding HSV-1 keratitis pathogenesis is key to managing treatment failures.
- A systematic work-up is necessary for refractory cases.
- Novel treatment strategies are needed for ACVR HSV-1 keratitis to prevent disease progression.
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