The Impact of Antiviral Resistance on Herpetic Keratitis

Moshirfar, Majid; Kelkar, Neil; Peterson, Telyn; Bradshaw, Justin M.; Parker, Lawsen; Ronquillo, Yasmyne C; Hoopes, Phillip C

doi:10.1097/icl.0000000000000952

Cited by 5 publications

(6 citation statements)

References 71 publications

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“…Acyclovir is the most common drug used in the management of HSK[ 169 ], although eyedrops are now being proposed[ 170 ]. Resistance to acyclovir occurs due to extended use[ 171 ], and mutation in the viral thymidylate kinase and DNA polymerase which decreases enzyme affinity for its substrate[ 172 - 174 ]. Topical cyclosporine drops and prednisolone acetate drops are statistically similar in potency for stemming inflammation and preventing scar development[ 175 ].…”

Section: Antiviral Therapy For Herpes Simplex Keratitis: Efficacy And...mentioning

confidence: 99%

Herpes simplex keratitis: A brief clinical overview

Musa,

Enaholo,

Aluyi-Osa

et al. 2024

World J Virol

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The aim of our minireview is to provide a brief overview of the diagnosis, clinical aspects, treatment options, management, and current literature available regarding herpes simplex keratitis (HSK). This type of corneal viral infection is caused by the herpes simplex virus (HSV), which can affect several tissues, including the cornea. One significant aspect of HSK is its potential to cause recurrent episodes of inflammation and damage to the cornea. After the initial infection, the HSV can establish a latent infection in the trigeminal ganglion, a nerve cluster near the eye. The virus may remain dormant for extended periods. Periodic reactivation of the virus can occur, leading to recurrent episodes of HSK. Factors triggering reactivation include stress, illness, immunosuppression, or trauma. Recurrent episodes can manifest in different clinical patterns, ranging from mild epithelial involvement to more severe stromal or endothelial disease. The severity and frequency of recurrences vary among individuals. Severe cases of HSK, especially those involving the stroma and leading to scarring, can result in vision impairment or even blindness in extreme cases. The cornea's clarity is crucial for good vision, and scarring can compromise this, potentially leading to visual impairment. The management of HSK involves not only treating acute episodes but also implementing long-term strategies to prevent recurrences and attempt repairs of corneal nerve endings via neurotization. Antiviral medications, such as oral Acyclovir or topical Ganciclovir, may be prescribed for prophylaxis. The immune response to the virus can contribute to corneal damage. Inflammation, caused by the body's attempt to control the infection, may inadvertently harm the corneal tissues. Clinicians should be informed about triggers and advised on measures to minimize the risk of reactivation. In summary, the recurrent nature of HSK underscores the importance of both acute and long-term management strategies to preserve corneal health and maintain optimal visual function.

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Section: Antiviral Therapy For Herpes Simplex Keratitis: Efficacy And...mentioning

confidence: 99%

Herpes simplex keratitis: A brief clinical overview

Musa,

Enaholo,

Aluyi-Osa

et al. 2024

World J Virol

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“…9,16, 17 Although current antivirals are still viable treatments for active herpetic diseases such as keratitis, controlling recurrence and the virus in the latent phase remains a challenge due to a virus in its latent state being resistant to all antiviral drugs. 14, [16][17][18] Vaccines targeting this viral group have not yet been developed, which increases the need for effective therapies that not only safely treat active herpesvirus infection, but also aim to prevent latent infection. Understanding the pathogenesis and virulence characteristics of herpesviruses can lead to new therapeutic targets to prevent the virus from entering, spreading and replicating.…”

Section: No Outbreaksmentioning

confidence: 99%

L-lysine as a Possible Supplement for Treatment of Herpetic Epithelial Keratitis: A Case Report and Literature Review

Pedrazini,

da Silva,

Odone

et al. 2024

J Explor Res Pharmacol

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Herpetic Epithelial Keratitis is characterized by a corneal dendritic lesion, and prolonged or recurrent medication such as acyclovir, raises the possibility of resistant strains, necessitating the search for new therapies. An 84-year-old woman, phototype III, reported severe discomfort in the left eye. The presence of a dendritic ulcer was confirmed. Acyclovir therapy (oral-1.6 g/ day and topical-seven days) was initiated and replaced by famciclovir (oral-1.5 g/day-seven days; topical acyclovir discontinued). Every three months, a new recurrence occurred. Famciclovir treatment (seven days) was subsequently supplemented with L-lysine (3 g-loading dose + 500 mg/day per 30 days) with L-arginine intake control. After amino acid supplementation, the clinical signs of the active lesion were reduced compared to previous treatment. Furthermore, a longer interval between recurrences was observed until they ultimately stopped. The patient is controlling L-arginine intake. When necessary, L-lysine supplementation is associated. Additional investigation is needed on the proposed supplementary therapy for Herpetic Epithelial Keratitis, which could help reduce side effects and resistance to antiviral drugs. However, as documented in this case report, amino acid supplementation can be recommended for controlling herpesvirus infection with no risk of adverse effects

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“…Efforts to address these challenges include developing innovative therapies targeting acyclovir-resistant herpes simplex keratitis. 272 Famciclovir is an alternative treatment option for genital herpes. 273,274 As substantiated by research findings, zinc has demonstrated the capacity to impede the viral life cycle of HSV.…”

Section: Current Antiviral Therapies For Hsv Infectionmentioning

confidence: 99%

Immunopathology of herpes simplex virus‐associated neuroinflammation: Unveiling the mysteries

Hussain,

Gupta,

Samuel

et al. 2023

Reviews in Medical Virology

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The immunopathology of herpes simplex virus (HSV)‐associated neuroinflammation is a captivating and intricate field of study within the scientific community. HSV, renowned for its latent infection capability, gives rise to a spectrum of neurological expressions, ranging from mild symptoms to severe encephalitis. The enigmatic interplay between the virus and the host's immune responses profoundly shapes the outcome of these infections. This review delves into the multifaceted immune reactions triggered by HSV within neural tissues, intricately encompassing the interplay between innate and adaptive immunity. Furthermore, this analysis delves into the delicate equilibrium between immune defence and the potential for immunopathology‐induced neural damage. It meticulously dissects the roles of diverse immune cells, cytokines, and chemokines, unravelling the intricacies of neuroinflammation modulation and its subsequent effects. By exploring HSV's immune manipulation and exploitation mechanisms, this review endeavours to unveil the enigmas surrounding the immunopathology of HSV‐associated neuroinflammation. This comprehensive understanding enhances our grasp of viral pathogenesis and holds promise for pioneering therapeutic strategies designed to mitigate the neurological ramifications of HSV infections.

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The Impact of Antiviral Resistance on Herpetic Keratitis

Cited by 5 publications

References 71 publications

Herpes simplex keratitis: A brief clinical overview

Herpes simplex keratitis: A brief clinical overview

L-lysine as a Possible Supplement for Treatment of Herpetic Epithelial Keratitis: A Case Report and Literature Review

Immunopathology of herpes simplex virus‐associated neuroinflammation: Unveiling the mysteries

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