Antiviral resistance in herpes simplex virus and varicella-zoster virus infections: diagnosis and management.
Aciclovir (ACV) is the first-line drug for the management of herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections. Long-term administration of ACV for the treatment of severe infections in immunocompromised patients can lead to the development of drug resistance. Furthermore, the emergence of isolates resistant to ACV is increasingly recognized in immunocompetent individuals with herpetic keratitis. This review describes the mechanisms involved in drug resistance for HSV and VZV, the laboratory diagnosis and management of patients with infections refractory to ACV therapy.



Genotypic testing is more frequently performed for the diagnosis of infections caused by drug-resistant HSV or VZV isolates. Molecular biology-based systems for the generation of recombinant viruses have been developed to link unknown mutations with their drug phenotypes. Fast and sensitive methods based on next-generation sequencing will improve the detection of heterogeneous viral populations of drug-resistant viruses and their temporal changes during antiviral therapy, which could allow better patient management. Novel promising compounds acting on targets that differ from the viral DNA polymerase are under clinical development.



Antiviral drug resistance monitoring for HSV and VZV is required for a rational use of antiviral therapy in high-risk populations.
Research Center in Infectious Diseases, CHU of Quebec and Laval University, Quebec City, Quebec, Canada.
Jocelyne
J
Piret
Guy
G
Boivin
D000212:Acyclovir / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D006561:Herpes Simplex / Q000188:drug therapy* / Q000821:virology; D006562:Herpes Zoster / Q000188:drug therapy / Q000821:virology; D014645:Herpesvirus 3, Human / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D007108:Immune Tolerance; D018139:Simplexvirus / Q000187:drug effects* / Q000235:genetics; D000073618:Varicella Zoster Virus Infection / Q000188:drug therapy* / Q000821:virology
D000998:Antiviral Agents; D000212:Acyclovir