Cidofovir use in acyclovir-resistant herpes infection

Area of Science:

• Virology
• Pharmacology
• Infectious Diseases

Background:

• Herpes simplex virus (HSV) infections are common, especially in immunocompromised individuals.
• Acyclovir resistance is a growing concern in HSV management.
• Limited human data exist for alternative treatments like cidofovir.

Purpose of the Study:

• To review the current evidence on cidofovir for HSV infections, focusing on acyclovir-resistant strains.
• To evaluate the efficacy and safety of cidofovir based on available animal and human studies.
• To identify potential therapeutic strategies involving cidofovir for refractory HSV.

Main Methods:

• Review of animal studies demonstrating cidofovir's efficacy in HSV treatment and prevention.
• Analysis of limited human data, including one randomized controlled trial and case reports.
• Assessment of cidofovir's pharmacokinetic profile and adverse effect profile.

Main Results:

• Animal studies indicate cidofovir is effective against HSV.
• A single human trial showed promising results, but requires larger studies.
• Case reports suggest cidofovir can overcome acyclovir resistance, though reporting quality is suboptimal.
• Intravenous cidofovir has efficacy but carries risks like nephrotoxicity and neutropenia.
• Topical cidofovir may minimize systemic adverse effects.

Conclusions:

• Cidofovir demonstrates potential as a treatment for acyclovir-resistant HSV infections.
• Alternating acyclovir and cidofovir may manage emerging resistance.
• Further large-scale clinical trials are essential to establish cidofovir's role in routine HSV therapy.
• Topical cidofovir warrants investigation for mucocutaneous HSV infections.