Successful treatment of an aciclovir-resistant herpes simplex type 2 infection with cidofovir in an AIDS patient

Br J Dermatol. 2002 Jul;147(1):134-8. doi: 10.1046/j.1365-2133.2002.04747.x.


Management of the increasing frequency of aciclovir-resistant herpes simplex virus (HSV) infections among immunocompromised human immunodeficiency virus-infected people demands additional treatment options. We report the case of a 38-year-old patient with acquired immune deficiency syndrome who suffered from a perianal butterfly ulcer, which was HSV-2 positive by polymerase chain reaction (PCR) analysis. The ulcer appeared during treatment of a cytomegalovirus (CMV) pneumonitis with ganciclovir. Despite additional valaciclovir therapy the lesion gradually progressed in size. Investigations including histology, PCR analysis and in situ hybridization of a biopsy from the growing ulcer margin confirmed the presence of HSV-2 infection. Importantly, HSV isolates from this specimen were resistant to aciclovir. Based on a report about the successful treatment of aciclovir-resistant HSV infection with cidofovir, our patient received this drug intravenously at a dose of 5 mg kg-1 body weight once weekly for a total of 3 weeks. Concomitant oral probenecid and prehydration were administered to minimize nephrotoxicity. Within 30 days of treatment the ulcer had almost (> 95%) completely healed. We conclude that cidofovir is a potent antiviral drug with a potential usefulness in the treatment of aciclovir-resistant HSV-2 infection. It deserves further investigation in clinical trials.

Publication types

  • Case Reports

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy*
  • Acyclovir / therapeutic use*
  • Adult
  • Antiviral Agents / therapeutic use*
  • Cidofovir
  • Cytosine / analogs & derivatives
  • Cytosine / therapeutic use*
  • Drug Resistance, Viral
  • Female
  • Fissure in Ano / drug therapy
  • Fissure in Ano / virology
  • Herpes Simplex / drug therapy*
  • Herpesvirus 2, Human*
  • Humans
  • Organophosphonates*
  • Organophosphorus Compounds / therapeutic use*


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