Long-term follow-up of HIV-infected patients once diagnosed with acyclovir-resistant herpes simplex virus infection

Abstract

Acyclovir-resistant herpes simplex virus (HSV) infection is common in immunocompromised patients, but the course of such infection is little known. We describe the long-term follow-up of HIV-infected patients diagnosed once with acyclovir-resistant HSV infections. We retrospectively studied all HIV-infected patients between 2000 and 2010 diagnosed with virologically confirmed acyclovir-resistant HSV infection. Patients' socio-demographic and immunovirological characteristics were described. Response to foscarnet or cidofovir and recurrences were reported. Among 5295 HIV-infected patients, 13 (0.2%) were once diagnosed with an acyclovir-resistant HSV infection. Twelve patients were men, nine patients were of African origin. All patients reported previous acyclovir exposure and median CD4 count was 183 cells/mm(3) Ten patients presented exclusively with cutaneous lesions. Initially, 11 patients were treated with foscarnet and two with cidofovir. The median follow-up was 67 months (6-145). All patients recurred, 10 presenting at least one acyclovir-resistant HSV recurrence. The median number of acyclovir-resistant HSV recurrences per patient was 2 (0 - 5). Regarding the first and second recurrences, 7/13 (54%) and 5/11 (45%) HSV clinical isolates exhibited resistance to acyclovir, respectively. Acyclovir-resistant HSV infection prevalence was low in our cohort. The rate of acyclovir-resistant HSV episodes averaged 50% during the two first recurrences.

Added value of ultra-deep sequencing (UDS) approach for detection of genotypic antiviral resistance of herpes simplex virus (HSV)

“…The percentage of TK frameshifts observed in our study is clearly above error rates observed in literature suggesting the results are not an artefact (Laehnemann et al, 2016). Those results are in agreement with previous data -obtained by cloning analyses, Sanger method, and other UDS technology -showing that heterogeneous populations (HSV TK-deficient and wild-type HSV mutants) may coexist within clinical isolates in variable proportions (Andrei et al, 2005;Piret and Boivin, 2011;Wang et al, 2007;Van velzen et al, 2012;Fujii et al, 2018;Duan et al, 2009;Seang et al, 2014). ().…”

Varicella-Infected Acquired Immunodeficiency Syndrome Patient with Secondary Infection

“…Susceptibility test of antiviral drugs for alternative therapies is conducted if there is a positive viral culture. Foscarnet can be given if there is a therapy failure (Seang et al, 2014).…”

Response to article – S Seang et al. Long-term follow-up of HIV-infected patients once diagnosed with acyclovir-resistant herpes simplex virus (Int J STD AIDS 2014; 25: 676–682)

“…We have read with interest the retrospective study: 'Long-term follow up of HIV-infected patients once diagnosed with aciclovir-resistant herpes simplex viruses'. 1 In the study, Seang et al reported some variable healing of aciclovir resistant lesions treated with imiquimod 5% cream. We have also seen a dramatic response to imiquimod treatment in aciclovir-resistant herpes.…”