Abstract
OBJECTIVES: To estimate the extent of aciclovir refractory herpes simplex virus (HSV) infection in HIV coinfected patients in the United Kingdom and survey clinicians on their approaches to its management. DESIGN: Questionnaire survey of representative sample of one third of United Kingdom HIV physicians. MAIN OUTCOME MEASURES: Use of antiviral therapies for genital HSV infections in HIV positive patients, reported frequency of aciclovir refractory HSV infection, its therapy, and access to antiviral susceptibility testing facilities. RESULTS: 53 responses were obtained (response rate 61%), representing a sample size of 23% of United Kingdom HIV physicians. Use of non-standard antiviral regimens for HSV infections in HIV coinfected patients was widely practised, irrespective of the clinical characteristics of the HSV infection. Aciclovir refractory HSV infection has been observed by 37 (70%) respondents. Although foscarnet was the most frequently used therapy, used by 27/37 (73%) respondents, in only seven of these 27 (19%) was it a first line treatment for aciclovir refractory cases, frequently being used at a late stage in the clinical course. Antiviral susceptibility testing facilities were available to 46 (87%) clinicians. No respondents reported any evidence of transmission of aciclovir resistant strains. CONCLUSIONS: HIV coinfection has a stronger influence on therapeutic choice than clinical immunosuppression or severity of herpetic infection. Aciclovir treatment failure is commoner than hitherto recognised. There is a need for wider awareness of use of foscarnet at an earlier stage in management of refractory HSV infection.
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- Balfour H. H., Jr, Benson C., Braun J., Cassens B., Erice A., Friedman-Kien A., Klein T., Polsky B., Safrin S. Management of acyclovir-resistant herpes simplex and varicella-zoster virus infections. J Acquir Immune Defic Syndr. 1994 Mar;7(3):254–260. [PubMed] [Google Scholar]
- Bean B., Fletcher C., Englund J., Lehrman S. N., Ellis M. N. Progressive mucocutaneous herpes simplex infection due to acyclovir-resistant virus in an immunocompromised patient: correlation of viral susceptibilities and plasma levels with response to therapy. Diagn Microbiol Infect Dis. 1987 Jul;7(3):199–204. doi: 10.1016/0732-8893(87)90005-8. [DOI] [PubMed] [Google Scholar]
- Birch C. J., Tyssen D. P., Tachedjian G., Doherty R., Hayes K., Mijch A., Lucas C. R. Clinical effects and in vitro studies of trifluorothymidine combined with interferon-alpha for treatment of drug-resistant and -sensitive herpes simplex virus infections. J Infect Dis. 1992 Jul;166(1):108–112. doi: 10.1093/infdis/166.1.108. [DOI] [PubMed] [Google Scholar]
- Englund J. A., Zimmerman M. E., Swierkosz E. M., Goodman J. L., Scholl D. R., Balfour H. H., Jr Herpes simplex virus resistant to acyclovir. A study in a tertiary care center. Ann Intern Med. 1990 Mar 15;112(6):416–422. doi: 10.7326/0003-4819-76-3-112-6-416. [DOI] [PubMed] [Google Scholar]
- Erlich K. S., Mills J., Chatis P., Mertz G. J., Busch D. F., Follansbee S. E., Grant R. M., Crumpacker C. S. Acyclovir-resistant herpes simplex virus infections in patients with the acquired immunodeficiency syndrome. N Engl J Med. 1989 Feb 2;320(5):293–296. doi: 10.1056/NEJM198902023200506. [DOI] [PubMed] [Google Scholar]
- Hardy W. D. Foscarnet treatment of acyclovir-resistant herpes simplex virus infection in patients with acquired immunodeficiency syndrome: preliminary results of a controlled, randomized, regimen-comparative trial. Am J Med. 1992 Feb 14;92(2A):30S–35S. doi: 10.1016/0002-9343(92)90335-9. [DOI] [PubMed] [Google Scholar]
- Sacks S. L., Wanklin R. J., Reece D. E., Hicks K. A., Tyler K. L., Coen D. M. Progressive esophagitis from acyclovir-resistant herpes simplex. Clinical roles for DNA polymerase mutants and viral heterogeneity? Ann Intern Med. 1989 Dec 1;111(11):893–899. doi: 10.7326/0003-4819-111-11-893. [DOI] [PubMed] [Google Scholar]
- Safrin S., Crumpacker C., Chatis P., Davis R., Hafner R., Rush J., Kessler H. A., Landry B., Mills J. A controlled trial comparing foscarnet with vidarabine for acyclovir-resistant mucocutaneous herpes simplex in the acquired immunodeficiency syndrome. The AIDS Clinical Trials Group. N Engl J Med. 1991 Aug 22;325(8):551–555. doi: 10.1056/NEJM199108223250805. [DOI] [PubMed] [Google Scholar]
- Tindall B., Cooper D. A. Primary HIV infection: host responses and intervention strategies. AIDS. 1991 Jan;5(1):1–14. [PubMed] [Google Scholar]