Emergence of acyclovir-resistant varicella zoster virus in an AIDS patient on prolonged acyclovir therapy.
We demonstrate for the first time the appearance of acyclovir resistance in serial varicella zoster isolates from a patient treated with acyclovir. We recovered varicella zoster virus three times over a period of 5 months from the skin lesions of this patient with AIDS who was treated with three courses of intravenous acyclovir and prolonged low-dose oral acyclovir. The isolate recovered from a typical zoster lesion before acyclovir, and one obtained from a hyperkeratotic lesion 2 months later, after intravenous and oral acyclovir, were sensitive to acyclovir and produced normal amounts of thymidine kinase. In contrast, virus recovered from lesions 5 months after the onset, when the patient had received repeated courses of acyclovir, was acyclovir-resistant and thymidine-kinase-deficient. Resistance to acyclovir was associated with persistence of lesions which failed to improve with intravenous acyclovir, but was not associated with new lesion formation.
Linnemann
C C
CC
Department of Medicine, University of Cincinnati College of Medicine, Ohio 45267-0560.
Biron
K K
KK
Hoppenjans
W G
WG
Solinger
A M
AM
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D000212:Acyclovir / Q000494:pharmacology* / Q000627:therapeutic use; D000328:Adult; D004352:Drug Resistance, Microbial; D005260:Female; D006562:Herpes Zoster / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D014645:Herpesvirus 3, Human / Q000187:drug effects*; D006801:Humans; D013937:Thymidine Kinase / Q000378:metabolism
D013937:Thymidine Kinase; D000212:Acyclovir