title: The role of antiviral therapy in immunocompromised patients with herpes simplex virus meningitis.
abstract: BACKGROUND
  Herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) are important causes of acute neurologic illness. Although the role of acyclovir in treating HSV encephalitis is clear, the role of antiviral therapy in HSV meningitis remains controversial.
  
  
  METHODS
  In this retrospective observational study, we reviewed the charts of all patients with cerebrospinal fluid specimens positive for HSV-1 or HSV-2 by polymerase chain reaction between July 2000 and November 2012. Patients' charts were reviewed for demographic data, clinical presentation, treatment, and clinical outcomes.
  
  
  RESULTS
  Forty-two patient-episodes were clinically classified as meningitis. In 6 episodes (14.3%), patients with meningitis received no antivirals, whereas the remaining episodes were treated with an oral antiviral (n = 11 [26.2%]), combination intravenous and oral therapy (n = 22 [52.4%]), or intravenous acyclovir alone (n = 3 [7.1%]). Six patients had recurrent episodes of meningitis and all recovered without any neurologic sequelae. Neurologic outcomes were significantly improved with antiviral therapy in immunocompromised patients with herpes meningitis (P < .05), but not in the 27 patient-episodes among immunocompetent patients (P = 1.0), as no neurologic sequelae were noted in this group.
  
  
  CONCLUSIONS
  Most patients with HSV meningitis rapidly improve, but immunocompromised hosts have more neurologic sequelae and may benefit from antiviral therapy. Our data suggest symptomatic treatment alone for immunocompetent patients with HSV meningitis, avoiding the cost and side effects of prolonged intravenous acyclovir therapy; in contrast, immunocompromised patients had improved outcomes and would therefore benefit from antiviral therapy.
authors.affiliation: Department of Infectious Diseases, Rhode Island Hospital and The Miriam Hospital, Brown University Affiliated Hospitals, Providence.
authors.forename: Amanda
authors.initials: A
authors.lastname: Noska
authors.affiliation: Department of Infectious Diseases, Lebanese Hospital University Medical Center, Beirut, Lebanon.
authors.forename: Ramona
authors.initials: R
authors.lastname: Kyrillos
authors.affiliation: Department of Pathology and Laboratory Medicine, Hennepin County Medical Center.
authors.forename: Glen
authors.initials: G
authors.lastname: Hansen
authors.affiliation: Department of Pathology and Laboratory Medicine, Hennepin County Medical Center.
authors.forename: Diane
authors.initials: D
authors.lastname: Hirigoyen
authors.affiliation: Departments of Medicine and Infectious Diseases, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis.
authors.forename: David N
authors.initials: DN
authors.lastname: Williams
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use*; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D002555:Cerebrospinal Fluid / Q000821:virology; D020803:Encephalitis, Herpes Simplex / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D018259:Herpesvirus 1, Human / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir
keywords: central nervous system infections; herpes simplex virus; immunocompromised; neurologic sequelae; treatment