Table 2.

Treatment Strategies Used for Acyclovir-Resistant HSV Infections

Time from HCT to HSV infection diagnosis (days)	Time from HCT to resistance (days)	Site of infection	Antiviral prophylaxis	Treatment	Total duration of antiviral therapy	Response to Therapy at 2 weeks	Treatment-related side effects
300	300	Anal	Oral valacyclovir prophylaxis 1	Oral valacyclovir treatment3 dose	80 days	Yes	None
9	49	Oral	Oral valacyclovir prophylaxis 1	IV acyclovir treatment dose4 for 21 days, followed by some resolution then oral valacyclovir, followed by IV foscarnet treatment dose5 for 40 days + topical cidofovir7 for 58 days	119 days ** (adjusted for renal function)	No	Renal failure
84	180	Anal	Oral valacyclovir prophylaxis 1	Oral valacyclovir treatment3 dose for 10 days, followed by IV foscarnet for 60 days treatment5 and maintenance for 40 days6*+ topical cidofovir7 for 40 days.	150 days ** (adjusted for renal function)	No	Renal failure, dialysis, need for hospitalization
94	110	Oral	Oral valacyclovir prophylaxis 1	Oral valacyclovir treatment3 for 40 days, then IV foscarnet treatment5 for 20 days, followed by IV cidofovir x18	60 days (adjusted for renal function)	Yes	None
46	52	Anal	Oral valacyclovir prophylaxis 1	Oral valacyclovir treatment3 dose for 10 days, followed by IV foscarnet treatment5 for 60 days	70 days ** (adjusted for renal function)	No*** (no response at 2 weeks of therapy, eventual response)	Renal failure, hospitalization
1	58	Genital	Oral valacyclovir prophylaxis 1	IV acyclovir4 for 14 days, followed by oral valacyclovir treatment3 dose with exacerbation for 30 days, followed by IV foscarnet treatment5 for 50 days with topical acyclovir	94 days ** (adjusted for renal function)	No	Renal failure, dialysis, hospitalization
7	89	Oral	Oral valacyclovir prophylaxis 1	IV acyclovir treatment4 for 28 days, followed by IV foscarnet treatment5 for 18 days	46 days	Yes	None
224	27	Oral	Oral valacyclovir prophylaxis 1	Oral valacyclovir treatment3 dose 10 days, then IV acyclovir treatment4 for 14 days, followed by IV foscarnet treatment5* 20 days, foscarnet maintenance* 10 days, plus topical cidofovir7/ imiquimod for 8 days	62 days ** (adjusted for renal function)	No	Renal failure, hospitalization
4	85	Anal, hepatitis	Oral valacyclovir prophylaxis 1	Oral valacyclovir treatment3 dose for 18 days with topical cidofovir7 for 5 days	18 days	Yes	None
16	44	Oral and genital HSV pneumonitis	Oral valacyclovir prophylaxis 1	Oral valacyclovir treatment3 dose for 28 days, followed by IV acyclovir treatment4 for 8 days, followed by IV foscarnet treatment/maintenance5* for 50 days +topical cidofovir7 /imiquimod 42 day.	128 days** (adjusted for renal function)	No	Renal failure
85	17	Oral	Oral valacyclovir prophylaxis 1	IV acyclovir treatment4 for 4 days, followed by IV foscarnet treatment5 for 4 days	8 days	No	Hospitalization
18	90	Oral	IV Acyclovir prophylaxis 2	Oral valacyclovir treatment3 for 8 days, then IV acyclovir treatment4 for 15 days, then IV foscarnet treatment5* for 60 days, then IV cidofovir x18	84 days ** (adjusted for renal function)	No*** (no response at 2 weeks of therapy, eventual response)	Renal failure
14	19	Oral	IV Acyclovir prophylaxis 2	IV acyclovir treatment4 for 40 days, then foscarnet treatment5 for 30 days, then IV cidofovir (once a week for 33 days) plus topical cidofovir7	103 days ** (adjusted for renal function)	No*** (no response at 2 weeks of therapy, eventual response)	Renal failure
31	44	Oral	Oral valacyclovir prophylaxis 1	Oral valacyclovir treatment3 dose for 14 days, then IV acyclovir for 7 days followed by foscarnet treamtent5 for 10 days	31 days	Yes	None
5	17	Oral	IV Acyclovir prophylaxis 2	Oral valacyclovir treatment3 dose for 15 days, followed by IV acyclovir treatment4 for 5 days, then IV foscarnet treatment5 for 25 days, then topical acyclovir for 40 days	49 days	No	None
41	90	Genital/anal	IV Acyclovir prophylaxis 2	IV acyclovir treatment4 for 25 days, then IV foscarnet treatment5 for 100 days, followed by topical cidofovir7/imiquimod on-off for 80 days	205 ** (adjusted for renal function)	No	Renal failure
735	741	Oral/cornea	Oral valacyclovir prophylaxis 1	IV acyclovir treatment4 5 days, followed by IV foscarnet treatment5 for 20 days then IV cidofovir for 600 days, plus topical cidofovir7	625 days ** (adjusted for renal function)	No*** (no response at 2 weeks of therapy, eventual response)	Renal failure
12	19	Oral/oropharyngeal Pneumonitis	Oral valacyclovir prophylaxis 1	IV acyclovir treatment4 for 14 days, then IV foscarnet treatment5* for 200 days, cidofovir IV on-off for 100 day +, cidofovir topical7 for 60 days	321 days ** (adjusted for renal function)	No*** (no response at 2 weeks of therapy, eventual response)	Renal failure, dialysis, hospitalization

¹Oral valacyclovir prophylaxis –used per internal standard of care practices. [15, 16]

²IV acyclovir prophylaxis used at 5mg/kg every 12 hours [35]

³Valcyclovir treatment dose used at 1 gram oral every 8 hours [15]

⁴IV acyclovir treatment dose used 5 to 10 mg /kg iv q 8 hours [35, 36]

⁵Foscarnet treatment dose used at 40 mg/kg/dose every 8 to 12 hours [37, 38]

⁶Foscarnet maintenance dose used at 90 mg/kg once daily- used on a patient with concomitant CMV infection

⁷Topical cidofovir dose used at 1% to 3% once daily [39]

⁸IV cidofovir dose used at 5mg/kg weekly[40, 41]

^*Indicates received foscarnet for concomitant CMV therapy