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Successful Treatment of Progressive Acyclovir-Resistant Herpes Simplex Virus Using Intravenous Foscarnet in a Patient With the Acquired Immunodeficiency Syndrome

Successful Treatment of Progressive Acyclovir-Resistant Herpes Simplex Virus Using Intravenous... Abstract • We report a case of orofacial herpes simplex virus (HSV) infection that was progressive despite multiple courses of acyclovir sodium in a patient with the acquired immunodeficiency syndrome. The viral isolate was shown to be resistant to acyclovir in vitro, but proved susceptible to vidarabine and foscarnet sodium (trisodium phosphonoformate). The patient failed to respond to a 2-week course of intravenous vidarabine. However, rapid improvement in the orofacial lesion occurred with intravenous foscarnet. Most HSV isolates that are resistant to acyclovir are spontaneous mutants partially or completely lacking in thymidine kinase. Because foscarnet is a direct inhibitor of HSV DNA polymerase, this compound is expected to have efficacy against acyclovir-resistant strains. This report documents successful treatment of clinically significant HSV with intravenous administration of foscarnet, suggesting that further study is indicated. (Arch Dermatol. 1989;125:1548-1550) References 1. Dorsky DI, Crumpacker, CS. Drugs five years later: acyclovir . Ann Intern Med. 1987;107:859-874.Crossref 2. Barry DW, Lehrman SN, Ellis MN. Clinical and laboratory experience with acyclovir-resistant herpes viruses . J Antimicrob Chemother. 1986;18( (suppl B) ):75-84. 3. Erlich KS, Mills J, Chatis P, et al. Acyclovir-resistant herpes simplex virus infections in patients with the acquired immunodeficiency syndrome . N Engl J Med. 1989;320:293-296.Crossref 4. Erlich KS, Jacobson MA, Koehler JE, et al. Foscarnet therapy for severe acyclovir-resistant herpes simplex virus type-2 infection in patients with the acquired immunodeficiency syndrome (AIDS) . Ann Intern Med. 1989;110:710-713.Crossref 5. Wade JC, McLauren C, Meyers JD. Frequency and significance of acyclovir-resistant herpes simplex virus isolated from marrow transplant patients receiving multiple courses of treatment with acyclovir . J Infect Dis. 1983;148:1077-1082.Crossref 6. Crumpacker CS, Schnipper LE, Marlowe SI, Kowalsky PN, Hershey BJ, Levin MJ. Resistance to antiviral drugs of herpes simplex virus isolated from a patient treated with acyclovir . N Engl J Med. 1982;396:343-346.Crossref 7. Jacobson MA, Mills J. Serious cytomegalovirus disease in the acquired immunodeficiency syndrome (AIDS) . Ann Intern Med. 1988;108:585-594.Crossref 8. Barton SE, Munday PE, Kinghorn GR, et al. Topical treatment of recurrent genital herpes simplex virus infections with trisodium phosphonoformate (foscarnet): double blind, placebo controlled, multicentre study . Genitourin Med. 1986;62:247-250. 9. Lawee D, Rosenthal D, Aoki FY, Portnoy J. Efficacy and safety of foscarnet for recurrent orolabial herpes: a multicentre randomized double-blind study . Can Med Assoc J. 1988;138:329-333. 10. Surbone A, Yarchoan R, McAtee N, et al. Treatment of the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex with a regimen of 3′azido-2′3′-dideoxythymidine (azidothymidine or zidovudine) and acyclovir . Ann Intern Med. 1988;108:534-540.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Successful Treatment of Progressive Acyclovir-Resistant Herpes Simplex Virus Using Intravenous Foscarnet in a Patient With the Acquired Immunodeficiency Syndrome

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Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1989.01670230090016
Publisher site
See Article on Publisher Site

Abstract

Abstract • We report a case of orofacial herpes simplex virus (HSV) infection that was progressive despite multiple courses of acyclovir sodium in a patient with the acquired immunodeficiency syndrome. The viral isolate was shown to be resistant to acyclovir in vitro, but proved susceptible to vidarabine and foscarnet sodium (trisodium phosphonoformate). The patient failed to respond to a 2-week course of intravenous vidarabine. However, rapid improvement in the orofacial lesion occurred with intravenous foscarnet. Most HSV isolates that are resistant to acyclovir are spontaneous mutants partially or completely lacking in thymidine kinase. Because foscarnet is a direct inhibitor of HSV DNA polymerase, this compound is expected to have efficacy against acyclovir-resistant strains. This report documents successful treatment of clinically significant HSV with intravenous administration of foscarnet, suggesting that further study is indicated. (Arch Dermatol. 1989;125:1548-1550) References 1. Dorsky DI, Crumpacker, CS. Drugs five years later: acyclovir . Ann Intern Med. 1987;107:859-874.Crossref 2. Barry DW, Lehrman SN, Ellis MN. Clinical and laboratory experience with acyclovir-resistant herpes viruses . J Antimicrob Chemother. 1986;18( (suppl B) ):75-84. 3. Erlich KS, Mills J, Chatis P, et al. Acyclovir-resistant herpes simplex virus infections in patients with the acquired immunodeficiency syndrome . N Engl J Med. 1989;320:293-296.Crossref 4. Erlich KS, Jacobson MA, Koehler JE, et al. Foscarnet therapy for severe acyclovir-resistant herpes simplex virus type-2 infection in patients with the acquired immunodeficiency syndrome (AIDS) . Ann Intern Med. 1989;110:710-713.Crossref 5. Wade JC, McLauren C, Meyers JD. Frequency and significance of acyclovir-resistant herpes simplex virus isolated from marrow transplant patients receiving multiple courses of treatment with acyclovir . J Infect Dis. 1983;148:1077-1082.Crossref 6. Crumpacker CS, Schnipper LE, Marlowe SI, Kowalsky PN, Hershey BJ, Levin MJ. Resistance to antiviral drugs of herpes simplex virus isolated from a patient treated with acyclovir . N Engl J Med. 1982;396:343-346.Crossref 7. Jacobson MA, Mills J. Serious cytomegalovirus disease in the acquired immunodeficiency syndrome (AIDS) . Ann Intern Med. 1988;108:585-594.Crossref 8. Barton SE, Munday PE, Kinghorn GR, et al. Topical treatment of recurrent genital herpes simplex virus infections with trisodium phosphonoformate (foscarnet): double blind, placebo controlled, multicentre study . Genitourin Med. 1986;62:247-250. 9. Lawee D, Rosenthal D, Aoki FY, Portnoy J. Efficacy and safety of foscarnet for recurrent orolabial herpes: a multicentre randomized double-blind study . Can Med Assoc J. 1988;138:329-333. 10. Surbone A, Yarchoan R, McAtee N, et al. Treatment of the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex with a regimen of 3′azido-2′3′-dideoxythymidine (azidothymidine or zidovudine) and acyclovir . Ann Intern Med. 1988;108:534-540.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Nov 1, 1989

References