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Tratamiento del virus del herpes simple resistente con aciclovir por infusión continua

J P Engel¹, J A Englund, C V Fletcher

¹Department of Medicine, University of Minnesota, Minneapolis.

|March 23, 1990

Resumen

La proctitis por el virus del herpes simple tipo 2 resistente al acíclovir en pacientes con SIDA se trató eficazmente con dosis altas de aciclovir sódico por infusión continua. Este método superó la resistencia viral vinculada a las alteraciones de la timidina quinasa, ofreciendo una opción segura para pacientes ambulatorios.

Área de la Ciencia:

Virología Virología.
Enfermedades infecciosas Enfermedades infecciosas.
Inmunología Inmunología.

Sus antecedentes:

Los pacientes con síndrome de inmunodeficiencia adquirida (SIDA) son susceptibles a las infecciones oportunistas graves.
El virus del herpes simple tipo 2 (HSV-2) puede causar proctitis ulcerosa grave, particularmente en personas inmunocomprometidas.
La resistencia al aciclovir en el HSV-2 es una preocupación clínica creciente, a menudo relacionada con mutaciones virales de la timidina quinasa.

Objetivo del estudio:

Evaluar la eficacia y seguridad de la dosis alta de aciclovir sodio por infusión continua en el tratamiento de la proctitis ulcerosa HSV-2 resistente al aciclovir en pacientes con SIDA.
Para investigar los mecanismos de la resistencia al aciclovir en aislamientos de HSV-2 de estos pacientes.

Principales métodos:

Se trató a dos pacientes con SIDA con proctitis ulcerosa grave debido al HSV-2 resistente al aciclovir.
El tratamiento consistió en 6 semanas de dosis altas de aciclovir sódico por infusión continua (1.52.0 mg/kg/hora).
Se analizaron aislamientos virales para los mecanismos de resistencia al aciclovir, centrándose en la actividad de la timidina quinasa.

Principales resultados:

Se lograron resultados de tratamiento exitosos en ambos pacientes con el régimen de perfusión continua.
Los aislados virales exhibieron resistencia al aciclovir debido a alteraciones de la timidina quinasa: un aislado carecía de actividad, el otro había alterado la especificidad del sustrato.
La terapia de infusión continua fue segura, bien tolerada en un entorno ambulatorio, con monitoreo regular.

Conclusiones:

El aciclovir sodio en dosis altas e infusión continua es un tratamiento eficaz para la proctitis ulcerosa HSV-2 resistente al aciclovir en pacientes con SIDA.
La comprensión de las mutaciones específicas de la timidina quinasa es crucial para el manejo de la resistencia al aciclovir.
El manejo ambulatorio con la infusión continua de aciclovir es una estrategia terapéutica viable y segura.

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