Successful treatment of an aciclovir-resistant herpes simplex type 2 infection with cidofovir in an AIDS patient.
Management of the increasing frequency of aciclovir-resistant herpes simplex virus (HSV) infections among immunocompromised human immunodeficiency virus-infected people demands additional treatment options. We report the case of a 38-year-old patient with acquired immune deficiency syndrome who suffered from a perianal butterfly ulcer, which was HSV-2 positive by polymerase chain reaction (PCR) analysis. The ulcer appeared during treatment of a cytomegalovirus (CMV) pneumonitis with ganciclovir. Despite additional valaciclovir therapy the lesion gradually progressed in size. Investigations including histology, PCR analysis and in situ hybridization of a biopsy from the growing ulcer margin confirmed the presence of HSV-2 infection. Importantly, HSV isolates from this specimen were resistant to aciclovir. Based on a report about the successful treatment of aciclovir-resistant HSV infection with cidofovir, our patient received this drug intravenously at a dose of 5 mg kg-1 body weight once weekly for a total of 3 weeks. Concomitant oral probenecid and prehydration were administered to minimize nephrotoxicity. Within 30 days of treatment the ulcer had almost (> 95%) completely healed. We conclude that cidofovir is a potent antiviral drug with a potential usefulness in the treatment of aciclovir-resistant HSV-2 infection. It deserves further investigation in clinical trials.
Kopp
T
T
Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, University of Vienna Medical School, Währinger Gürtel 18-20, Austria. tamara.kopp@akh-wien.ac.at
Geusau
A
A
Rieger
A
A
Stingl
G
G
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000212:Acyclovir / Q000627:therapeutic use*; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D000077404:Cidofovir; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy / Q000821:virology; D006561:Herpes Simplex / Q000188:drug therapy*; D018258:Herpesvirus 2, Human; D006801:Humans; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000627:therapeutic use*
D000998:Antiviral Agents; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D003596:Cytosine; D000077404:Cidofovir; D000212:Acyclovir