Resistant Herpes Simplex Virus Type 1 Infection: An Emerging Concern After Allogeneic Stem Cell Transplantation

Clin Infect Dis. 2000 Oct;31(4):927-35. doi: 10.1086/314052. Epub 2000 Oct 10.

Abstract

Fourteen cases of severe acyclovir-resistant herpes simplex virus type 1 (HSV-1) infection, 7 of which showed resistance to foscarnet, were diagnosed among 196 allogeneic stem cell transplant recipients within a 29-month period. Recipients of unrelated stem cell transplants were at higher risk. All patients received foscarnet; 8 subsequently received cidofovir. Strains were initially foscarnet-resistant in 3 patients and secondarily so in 4 patients. In vitro resistance to acyclovir or foscarnet was associated with clinical failure of these drugs; however, in vitro susceptibility to foscarnet was associated with complete response in only 5 of 7 patients. No strain from any of the 7 patients was resistant in vitro to cidofovir; however, only 3 of 7 patients achieved complete response. Therefore, acyclovir- and/or foscarnet-resistant HSV-1 infections after allogeneic stem cell transplantation have become a concern; current strategies need to be reassessed and new strategies must be evaluated in this setting.

Publication types

  • Case Reports

MeSH terms

  • Acyclovir / therapeutic use
  • Adolescent
  • Adult
  • Antiviral Agents / therapeutic use
  • Child
  • Cidofovir
  • Cytosine / analogs & derivatives
  • Cytosine / therapeutic use
  • Drug Resistance, Microbial
  • Female
  • Foscarnet / therapeutic use
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Herpes Simplex / drug therapy*
  • Herpes Simplex / etiology*
  • Herpes Simplex / virology
  • Herpesvirus 1, Human / drug effects
  • Herpesvirus 1, Human / isolation & purification
  • Humans
  • Male
  • Middle Aged
  • Organophosphonates*
  • Organophosphorus Compounds / therapeutic use
  • Transplantation, Homologous

Substances

  • Antiviral Agents
  • Organophosphonates
  • Organophosphorus Compounds
  • Foscarnet
  • Cytosine
  • Cidofovir
  • Acyclovir