Resistant herpes simplex virus type 1 infection: an emerging concern after allogeneic stem cell transplantation.
Fourteen cases of severe acyclovir-resistant herpes simplex virus type 1 (HSV-1) infection, 7 of which showed resistance to foscarnet, were diagnosed among 196 allogeneic stem cell transplant recipients within a 29-month period. Recipients of unrelated stem cell transplants were at higher risk. All patients received foscarnet; 8 subsequently received cidofovir. Strains were initially foscarnet-resistant in 3 patients and secondarily so in 4 patients. In vitro resistance to acyclovir or foscarnet was associated with clinical failure of these drugs; however, in vitro susceptibility to foscarnet was associated with complete response in only 5 of 7 patients. No strain from any of the 7 patients was resistant in vitro to cidofovir; however, only 3 of 7 patients achieved complete response. Therefore, acyclovir- and/or foscarnet-resistant HSV-1 infections after allogeneic stem cell transplantation have become a concern; current strategies need to be reassessed and new strategies must be evaluated in this setting.
Chen
Y
Y
Service d'Hématologie-Greffe de Moelle, Hôpital Saint-Louis, Paris, France.
Scieux
C
C
Garrait
V
V
Socié
G
G
Rocha
V
V
Molina
J M
JM
Thouvenot
D
D
Morfin
F
F
Hocqueloux
L
L
Garderet
L
L
Espérou
H
H
Sélimi
F
F
Devergie
A
A
Leleu
G
G
Aymard
M
M
Morinet
F
F
Gluckman
E
E
Ribaud
P
P
D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D000077404:Cidofovir; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006561:Herpes Simplex / Q000188:drug therapy* / Q000209:etiology* / Q000821:virology; D018259:Herpesvirus 1, Human / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000627:therapeutic use; D014184:Transplantation, Homologous
D000998:Antiviral Agents; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D017245:Foscarnet; D003596:Cytosine; D000077404:Cidofovir; D000212:Acyclovir