Infections Caused by Herpes Simplex Virus in the Immunocompromised Host: Natural History And Topical Acyclovir Therapy

Abstract

Sixty-three immunocompromised patients with infections caused by herpes simplex virus were evaluated in a double-blind, placebo-controlled study of topical acyclovir therapy; 33 patients received acyclovir and 30 received the placebo. The two populations of patients were balanced in terms of age, race, sex, underlying disease, preceding chemotherapy, and site, size, and duration of lesions. Acyclovir recipients experienced an acceleration in the clearance of virus (P = .0006), the resolution of pain (P = .004), and the total healing of lesions (P = .038); median temporal differences between populations averaged six days for each of these three parameters. The surface area of herpetic lesions continued to enlarge in placebo recipients after entry into the trial; in contrast, lesion surface area decreased progressively during therapy in drug recipients. The speed of healing was influenced by lesion size. Patients with lesions of greater than or equal to 50 mm2 benefited most from therapy, particularly in terms of pain resolution and time to total healing (median differences between groups, eight days). Irrespective of underlying disease, sex, preceding chemotherapy, or age, acyclovir therapy was of clinical benefit. No adverse clinical or laboratory reactions were encountered.

Herpes Simplex Virus Resistance to Acyclovir and Penciclovir after Two Decades of Antiviral Therapy

“…These lesions are often larger than normal with deeper and more extensive ulceration, may have a heaped-up hyperkeratotic or verrucous appearance, may develop in atypical areas (e.g., sacral genital herpes confused with decubitus ulceration), and may persist for long periods (41,87,88,94,100). Lesions also remain culture positive for HSV for extended periods (85,100), in contrast to infections in immunocompetent patients, where HSV is cleared within a few days (3,89). The recurrence of severe mucosal lesions (oral or genital) is also much more common in immunocompromised patients, and unusual manifestations such as glossitis and papillitis occur, affecting the tongue and papillae of the gums, respectively.…”

Mixed viral infections: detection and management

“…Immunocompromised patients excrete virus longer than immunocompetent patients (12,21,34,47). Latent viruses, such as HSVs and CMV, are commonly reactivated and may produce chronic infections (40,108,109). Adenovirus infections also become prolonged and may result in serious disease (54,116 (58) and enzyme immunoassay (EIA) (8,16,85,86,114).…”

Acyclovir prophylaxis for herpes simplex virus infection

“…Reactivation of HSV infection is a major cause of morbidity in IC patients (62,64); seropositive recipients of bone marrow and organ transplants, patients with hematologic malignancies undergoing induction chemotherapy, patients with acquired immunodeficiency syndrome (AIDS), malnourished patients, patients with extensive burns, and individuals with primary immunodeficiency syndromes develop more frequent and severe outbreaks of HSV (19,62,64). A total of 50 to 80% of seropositive bone marrow or renal transplant recipients or acute leukemics undergoing induction chemotherapy experience reactivation of HSV, usually during the first 30 days after transplant (45,46,48).…”