Successful Treatment of Progressive Acyclovir-Resistant Herpes Simplex Virus Using Intravenous Foscarnet in a Patient With the Acquired Immunodeficiency Syndrome

Rk, Sall; Cl, Kauffman; Cs, Levy

doi:10.1001/archderm.1989.01670230090016

Cited by 21 publications

(3 citation statements)

References 9 publications

(4 reference statements)

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“…Herpes strains can become resistant to acyclovir, and HSV infection due to acyclovir-resistant virus is most commonly treated with foscarnet or cidofovir. Response of classic cutaneous herpes to foscarnet is relatively rapid (7–10 days) [13, 14]. However, foscarnet and cidofovir are potentially nephrotoxic and require intravenous administration.…”

Section: Discussionmentioning

confidence: 99%

Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus Infection in an HIV Patient

Roger¹,

Anstead

2017

Case Reports in Infectious Diseases

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The patient is a 52-year-old African American man with a past medical history of HIV infection (on antiretroviral therapy, CD4 count 399 cells/µL, and undetectable HIV viral load) and recurrent genital herpes. While on valacyclovir, the patient presented with four tumorous lesions on the perineum and scrotum. A biopsy specimen stained positively with HSV-1 and HSV-2 immunostains and displayed a lymphoplasmacytic infiltrate. The patient received foscarnet and imiquimod for two weeks with minimal improvement. Based on the previous activity of leflunomide, which has both antiviral and immunomodulatory properties, in cytomegalovirus and herpes simplex infections, leflunomide 20 mg orally twice daily was started. The patient received 23 days of foscarnet, 14 days of topical imiquimod, and 11 days of leflunomide with approximately 80% reduction in the size of the perineal lesion. After nine months on leflunomide there was complete regression of the large perineal lesion and only two small ulcerations remained on the scrotum. Pseudotumoral herpes lesions in HIV patients represent an immune reconstitution event and are poorly responsive to the usual anti-herpes agents. This report demonstrates the successful use of leflunomide in the treatment of an HIV patient with pseudotumoral herpes. Thalidomide has also been used with some success.

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Section: Discussionmentioning

confidence: 99%

Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus Infection in an HIV Patient

Roger¹,

Anstead

2017

Case Reports in Infectious Diseases

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“…The drug acts as a noncompetitive inhibitor of the DNA pol enzymatic activity by binding directly to its pyrophosphate binding site and blocking the cleavage of pyrophosphate from the nucleoside triphosphate, thus impeding further elongation of the viral DNA (Arduino & Porter, 2008;Piret & Boivin, 2011;Poole & James, 2018). Studies in HIV positive individuals and HSCT recipients, including isolated cases reports as well as randomized phase II trials, show that intravenous administration of FOS is effective in treating severe ACVr HSV-1 and -2 mucocutaneous lesions, since it reduces viral shedding along with the size and duration of lesions (Chatis et al, 1989;Iino et al, 1996;MacPhail et al, 1989;Naik et al, 1995;Sall et al, 1989;Verdonck et al, 1993), being more efficacious and showing less toxicity compared to vidarabine (Safrin et al, 1991). A few reports have also shown good results using FOS cream 1%-2.4% for the treatment of orogenital and cutaneous ACVr HSV lesions (Heidenreich et al, 2020;Javaly et al, 1999;Pechère et al, 1998; Table 1).…”

Section: Foscarnet (Fos)mentioning

confidence: 99%

Management of oral herpes simplex virus infections: The problem of resistance. A narrative review

et al. 2023

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Herpes Simplex Virus (HSV) type 1 (HSV‐1) and type 2 (HSV‐2) are among the most common human viral pathogens, affecting several billion people worldwide. Although in healthy patients clinical signs and symptoms of HSV infection are usually mild and self‐limiting, HSV‐infections in immunocompromised patients are frequently more aggressive, persistent, and even life‐threatening. Acyclovir and its derivatives are the gold standard antiviral drugs for the prevention and treatment of HSV infections. Although the development of acyclovir resistance is a rather uncommon condition, it may be associated with serious complications, especially in immunocompromised patients. In this review, we aim to address the problem of drug resistant HSV infection and discuss the available alternative therapeutic interventions. All relative studies concerning alternative treatment modalities of acyclovir resistant HSV infection published in PubMed between 1989 to 2022 were reviewed. Long‐term treatment and prophylaxis with antiviral agents predisposes to drug resistance, especially in immunocompromised patients. Cidofovir and foscarnet could serve as alternative treatments in these cases. Although rare, acyclovir resistance may be associated with severe complications. Hopefully, in the future, novel antiviral drugs and vaccines will be available in order to avoid the existing drug resistance.

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“…Similar sensitivity and clinical responsiveness to foscarnet sodium have been docu¬ mented in acyclovir-resistant strains of herpes sim¬ plex virus. 13 …”

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confidence: 99%

Prolonged Cutaneous Herpes Zoster in Acquired Immunodeficiency Syndrome

Hoppenjans

Bibler²,

Orme³

et al. 1990

Arch Dermatol

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We described the development of prolonged disseminated cutaneous herpes zoster in two patients with acquired immunodeficiency syndrome. Both patients developed hyperkeratotic, verrucous lesions that progressed despite acyclovir therapy. The biopsy specimens were typical of herpes infection. The development of acyclovir-resistant varicella-zoster virus during therapy was suspected clinically in the first patient and documented in vitro in the second patient. The inability to mount an effective cell-mediated immune response contributed to the prolonged course of cutaneous zoster in our patients. The hyperkeratotic nature of the skin lesions may reflect their chronic nature. Treatment with inadequate doses of acyclovir, allowing viral persistence and the selection of resistant strains of virus, may also be implicated. We recommend prolonged high-dose intravenous acyclovir therapy in the initial management of herpes zoster in patients with acquired immunodeficiency syndrome.

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Successful Treatment of Progressive Acyclovir-Resistant Herpes Simplex Virus Using Intravenous Foscarnet in a Patient With the Acquired Immunodeficiency Syndrome

Cited by 21 publications

References 9 publications

Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus Infection in an HIV Patient

Leflunomide in the Treatment of a Pseudotumoral Genital Herpes Simplex Virus Infection in an HIV Patient

Management of oral herpes simplex virus infections: The problem of resistance. A narrative review

Prolonged Cutaneous Herpes Zoster in Acquired Immunodeficiency Syndrome

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