Infection due to aciclovir resistant herpes simplex virus in patients undergoing allogeneic hematopoetic stem cell transplantation

Management of HSV, VZV and EBV infections in patients with hematological malignancies and after SCT: guidelines from the Second European Conference on Infections in Leukemia

“…The emergence of resistant HSV strains that cause disease unresponsive to antiviral drugs has been reported in patients with hematological malignancy. [31][32][33][34][35][36][37][38][39][40][41][42] Interestingly, a long duration of acyclovir prophylaxis is associated with low probability of HSV-resistant disease in SCT recipients. 43 Resistance to acyclovir is associated with prolonged HSV reactivation, but severe disease is infrequent.…”

“…36,44,47,48 Acyclovir-resistant HSV isolates are susceptible to other antiviral agents, such as foscarnet or cidofovir, that do not require viral thymidine kinase for activation. 38,[40][41][42][43][44][45][46]49 A randomized study comparing foscarnet with vidarabine showed superior efficacy and less frequent toxicity in the group receiving foscarnet. 49 Foscarnet may be used as an alternative treatment for acyclovir-resistant HSV disease in leukemic patients, and should be given with hydration to minimize its potential renal toxicity, especially in those who are exposed to other potentially nephrotoxic agents.…”

“…36,50 More recently, the presence of multidrug-resistant HSV strains was documented in several SCT recipients, including, not infrequently, foscarnet. [38][39][40][41][42] Many clinical strains of the virus are susceptible to cidofovir, and this agent was efficient in some patients with multidrug-resistant HSV disease. [38][39][40][41][42] If HSV disease is unresponsive to antiviral therapy given at appropriate dose, resistance testing should be performed (CIII).…”

Topical Administration Is a Promising Inoculating Route versus Intramuscular Inoculation for the Nanoparticle-Carried DNA Vaccine to Prevent Corneal Infections

“…Although such treatments may control the disease to some extent, they are still far away from satisfactory in curing the disease and controlling the spread of viruses [2]. In addition, long-term drug administration may result in side effects as well as drug tolerance [3,4,5,6,7]. Many investigators consider that the generation of specific active immune responses against viruses may be the most effective approach to control viral infections, therefore efforts are made in designing vaccines which can induce strong specific active antiviral immune responses [8,9,10].…”

Herpesvirus Infections in Organ Transplant Recipients

“…HSV infection transmitted by means of transplanted corneas to HSV-seronegative recipients can result in serious HSV disease (87). These infections are increasingly caused by antiviral-drug-resistant HSV mutants that evolve under pressure of prophylactic as well as therapeutic drug regimens (10,13,54,113).…”