Resistant herpes simplex virus infections – who, when, and what's new?

Abstract

Purpose of reviewThis review summarizes the literature on acyclovir resistant herpes infections and the most recent data pertinent to diagnosis and treatment in the immunocompromised patient population. Recent findingsAlthough fairly rare, acyclovir resistant herpes infections can be challenging to diagnose. Clinicians should be aware of this entity when facing refractory herpes infections. With updated diagnostics, the diagnosis is usually made through viral culture and sequencing. Therapeutic choices depend on the extent of disease. Topical therapy may be appropriate for mucocutaneous disease. Intravenous antiviral therapies such as foscarnet and cidofovir may be necessary for disseminated, ophthalmologic, central nervous system, or visceral disease. Experimental therapies such as pritelivir are in clinical trials.

Salvage Treatment of Refractory HSV Oral Lesions with Pritelivir in Allogeneic Hematopoietic Cell Transplant Recipients

“…We report two complex cases of acyclovir-resistant HSV-1 infections in allogeneic HCT recipients that were successfully treated with a new helicase-primase inhibitor, pritelivir, as salvage therapy. The increasing pool of highly immunocompromised hosts who remain on (val)acyclovir primary prophylaxis for a long duration has led to higher rates of acyclovir-r/r HSV infections, with only i.v.-administered, potentially nephrotoxic treatment options currently available (3,4,6,9). New effective and safe alternative treatment options are urgently needed.…”

Clinical infections in neurosurgical oncology: An overview

“…Viral meningoencephalitis is a condition referring to inflammation of the brain and meninges (meningitis), resulting from a viral infection[ 80 ].…”

“…There are two types of herpes simplex virus (type 1 and type 2) that cause meningoencephalitis, but infection with herpes simplex virus type 1 is more common. Other viral agents include enteroviruses, Varicella-Zoster virus, measles virus, HIV, Japanese encephalitis virus, Epstein-Barr virus and mumps[ 80 , 83 ].…”

Variant Analysis of the Thymidine Kinase and DNA Polymerase Genes of Herpes Simplex Virus in Korea: Frequency of Acyclovir Resistance Mutations

“…Herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2) are double-stranded DNA viruses of approximately 150 kbp in size that cause orolabial and genital skin infection, keratitis, encephalitis, and neonatal disease [ 1 , 2 ]. Acyclovir and penciclovir, with their respective prodrugs valacyclovir and famciclovir targeting DNA polymerase, are first-line antiviral agents for HSV infection treatment [ 1 ].…”