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Resistance of herpes simplex viruses to nucleoside analogues: mechanisms, prevalence, and management. Antimicrob Agents Chemother 2010; 55:459-72. [PMID: 21078929 DOI: 10.1128/aac.00615-10] [Citation(s) in RCA: 338] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Herpes simplex viruses (HSV) type 1 and type 2 are responsible for recurrent orolabial and genital infections. The standard therapy for the management of HSV infections includes acyclovir (ACV) and penciclovir (PCV) with their respective prodrugs valacyclovir and famciclovir. These compounds are phosphorylated by the viral thymidine kinase (TK) and then by cellular kinases. The triphosphate forms selectively inhibit the viral DNA polymerase (DNA pol) activity. Drug-resistant HSV isolates are frequently recovered from immunocompromised patients but rarely found in immunocompetent subjects. The gold standard phenotypic method for evaluating the susceptibility of HSV isolates to antiviral drugs is the plaque reduction assay. Plaque autoradiography allows the associated phenotype to be distinguished (TK-wild-type, TK-negative, TK-low-producer, or TK-altered viruses or mixtures of wild-type and mutant viruses). Genotypic characterization of drug-resistant isolates can reveal mutations located in the viral TK and/or in the DNA pol genes. Recombinant HSV mutants can be generated to analyze the contribution of each specific mutation with regard to the drug resistance phenotype. Most ACV-resistant mutants exhibit some reduction in their capacity to establish latency and to reactivate, as well as in their degree of neurovirulence in animal models of HSV infection. For instance, TK-negative HSV mutants establish latency with a lower efficiency than wild-type strains and reactivate poorly. DNA pol HSV mutants exhibit different degrees of attenuation of neurovirulence. The management of ACV- or PCV-resistant HSV infections includes the use of the pyrophosphate analogue foscarnet and the nucleotide analogue cidofovir. There is a need to develop new antiherpetic compounds with different mechanisms of action.
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Abstract
In immunocompetent patients, HSV is controlled rapidly by the human host's immune system, and recurrent lesions are small and short lived. When treated with antiviral agents, these patients rarely develop resistance to these drugs. In contrast immunocompromised patients might not be able to control HSV infection. Thus, frequent and severe reactivations are often seen and might lead to fatal herpetic encephalitis or disseminated HSV infection. Treatment in these patients is limited because immunocompromised hosts often develop severe herpes disease refractory to antiviral drug therapy. It is therefore imperative that physicians develop regimens to deal with both receptive and refractory HSV disease. The following treatment protocol (modified from Balfour and colleagues) might serve as a guide until further investigation of new drugs is performed. In all patients standard oral ACV therapy should be initiated at a dose of 200 mg orally, five times a day for the first 3 to 5 days. Prior to treatment, cultures the lesions should be obtained to verify HSV etiology. If the response is poor, the dose of oral ACV should be increased to 800 mg five times a day. If no response seen after 5 to 7 days, it is unlikely that the lesion will respond to intravenous ACV (or chemically and structurally related drugs such as VCV or famciclovir), so an alternative regimen must be assigned. First, repeat cultures for vital, fungal, and bacterial pathogens must be performed. In addition, ACV susceptibility studies should be ordered, if available. If the mucocutaneous lesion is accessible for topical treatment, TFT (as ophthalmic solution) should be applied to the area three to four times a day until the lesion is completely healed. If the lesion is inaccessible or if the response to TFT is poor, therapy with intravenous foscarnet should be given for 10 days or until complete resolution of the lesions. The dosage of foscarnet should be 40 milligrams per kilogram three times per day or 60 milligrams per kilogram twice daily. If foscarnet fails to achieve clinical clearing, consideration should be given to use of intravenous cidofovir (or application of compounded 1% to 3% topical cidofovir ointment). Vidarabine is reserved for situations in which all of these therapies fail. If lesions reoccur in the same location following clearing, the patient should started on high-dose oral ACV (800 mg, five times daily) or intravenous foscarnet (40 mg/kg tid or 60 mg/kg bid) as soon as possible. When lesions occur in a different location, the patient should be treated initially with standard doses of oral ACV (200 mg, five times daily) and the above protocol should be followed should there be clinical failure. In the future, new treatment options for patients with documented HSV resistance will be important in reducing the clinical impact of HSV.
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Affiliation(s)
- Suneel Chilukuri
- Department of Dermatology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030, USA
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Rabella N, Otegui M, Labeaga R, Rodríguez P, Margall N, Gurguí M, Prats G. Antiviral susceptibility of Herpes simplex viruses and its clinical correlates: a single center's experience. Clin Infect Dis 2002; 34:1055-60. [PMID: 11914993 DOI: 10.1086/339490] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2001] [Revised: 11/27/2001] [Indexed: 11/03/2022] Open
Abstract
The in vitro susceptibility to acyclovir of 204 herpes simplex virus isolates from 165 immunocompromised patients treated at our hospital was determined by the cytopathic effect reduction assay. Approximately 95% of herpes simplex virus 1 and 73% of herpes simplex virus 2 isolates were inhibited by acyclovir at concentrations of <2 microgram/mL. From 8 patients (5%), an isolate with low susceptibility to acyclovir (50% inhibitory dose, >3 microgram/mL) was recovered. Medical records of 83 patients were reviewed. Lesions resolved in most of the patients, independent of treatment. Treatment failures were not always associated with isolation of an in vitro-resistant virus. On the contrary, when a virus with low susceptibility to acyclovir was isolated, resolution of the lesion was the rule. In 9 of 10 patients with subsequent recurrent episodes of disease, the susceptibility of the viruses isolated was similar to that of the first episode. Routine susceptibility testing in our geographic area is not encouraged because of the low incidence of acyclovir-resistant herpes simplex viruses.
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Affiliation(s)
- N Rabella
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.
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Lipsitch M, Bacon TH, Leary JJ, Antia R, Levin BR. Effects of antiviral usage on transmission dynamics of herpes simplex virus type 1 and on antiviral resistance: predictions of mathematical models. Antimicrob Agents Chemother 2000; 44:2824-35. [PMID: 10991866 PMCID: PMC90157 DOI: 10.1128/aac.44.10.2824-2835.2000] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2000] [Accepted: 07/25/2000] [Indexed: 11/20/2022] Open
Abstract
Herpes simplex virus type 1 (HSV-1) causes recurrent herpes labialis (RHL), a common disease afflicting up to 40% of adults worldwide. Mathematical models are used to analyze the effect of antiviral treatment on the transmission of, and the prevalence of drug resistance in, HSV-1 in the United States. Three scenarios are analyzed: no antiviral use, the current level of use, and a substantial increase in nucleoside analogue use, such as might occur if topical penciclovir were available over-the-counter for the treatment of RHL. A basic model predicts that present level of nucleoside analogue use has a negligible effect on HSV-1 transmission and that even if use of topical penciclovir for (RHL) increased substantially, the overall prevalence of infectious HSV-1 is unlikely to be reduced by more than 5%. An expanded model, which allows for acquired resistance and includes immunocompromised hosts and other more realistic features, predicts that current antiviral use is unlikely to lead to any noticeable increase in resistance. If antiviral use increases, the resulting rise in resistance in the population will depend primarily on the probability that immunocompetent hosts will acquire permanent resistance upon treatment. This probability is known to be small, but its exact value remains uncertain. If acquired resistance occurs less than once per 2,500 treated episodes, then in the community at large, the frequency of HSV-1 resistance is predicted to increase slowly, if at all (remaining below 0.5% for >50 years), even with extensive nucleoside analogue use. If acquired resistance emerges in 1 of 625 treated episodes (the maximum of an approximate 95% confidence interval derived from the results of several studies of resistance in treated hosts), then the prevalence of infection with resistant HSV-1 could rise from about 0.2% to 1.5 to 3% within 50 years. The limitations of existing data on acquired resistance and the potential impact of acquired resistance if it occurs are discussed, and strategies are suggested for enhancing information on acquired resistance. The predictions of this model contrast with the more rapid increases in antimicrobial resistance anticipated by models and observed for other pathogenic bacteria and viruses. The reasons for these contrasting predictions are discussed.
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Affiliation(s)
- M Lipsitch
- Department of Biology, Emory University, Atlanta, Georgia 30322, USA.
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Piret J, Désormeaux A, Cormier H, Lamontagne J, Gourde P, Juhász J, Bergeron MG. Sodium lauryl sulfate increases the efficacy of a topical formulation of foscarnet against herpes simplex virus type 1 cutaneous lesions in mice. Antimicrob Agents Chemother 2000; 44:2263-70. [PMID: 10952566 PMCID: PMC90056 DOI: 10.1128/aac.44.9.2263-2270.2000] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The influence of sodium lauryl sulfate (SLS) on the efficacies of topical gel formulations of foscarnet against herpes simplex virus type 1 (HSV-1) cutaneous infection has been evaluated in mice. A single application of the gel formulation containing 3% foscarnet given 24 h postinfection exerted only a modest effect on the development of herpetic skin lesions. Of prime interest, the addition of 5% SLS to this gel formulation markedly reduced the mean lesion score. The improved efficacy of the foscarnet formulation containing SLS could be attributed to an increased penetration of the antiviral agent into the epidermis. In vitro, SLS decreased in a concentration-dependent manner the infectivities of herpesviruses for Vero cells. SLS also inhibited the HSV-1 strain F-induced cytopathic effect. Combinations of foscarnet and SLS resulted in subsynergistic to subantagonistic effects, depending on the concentration used. Foscarnet in phosphate-buffered saline decreased in a dose-dependent manner the viability of cultured human skin fibroblasts. This toxic effect was markedly decreased when foscarnet was incorporated into the polymer matrix. The presence of SLS in the gel formulations did not alter the viabilities of these cells. The use of gel formulations containing foscarnet and SLS could represent an attractive approach to the treatment of herpetic mucocutaneous lesions, especially those caused by acyclovir-resistant strains.
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Affiliation(s)
- J Piret
- Centre de Recherche en Infectiologie, Université Laval, Québec, Canada
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de la Iglesia P, Melón S, López B, Rodriguez M, Blanco MI, Mellado P, de Oña M. Rapid screening tests for determining in vitro susceptibility of herpes simplex virus clinical isolates. J Clin Microbiol 1998; 36:2389-91. [PMID: 9666034 PMCID: PMC105060 DOI: 10.1128/jcm.36.8.2389-2391.1998] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The susceptibility of human herpes simplex virus (HSV) to acyclovir (ACV) was determined with the use of a single dose of the drug (1 and 2 micrograms of ACV per ml for HSV-1 and HSV-2, respectively) in two rapid assays: a rapid cytopathic effect inhibitory assay (Rapid CIA) and a rapid dye uptake assay (Rapid DUA). These tests allow the simultaneous determination of virus titer and susceptibility to ACV at a determined viral concentration (100 50% tissue culture infective doses and 100 50% dye uptake units). These tests were compared with a conventional susceptibility assay (dye uptake assay) and showed similar results. Indeterminate results with the Rapid CIA appeared in 3 of 30 samples. With the use of both Rapid CIA and Rapid DUA, we were able to determine the susceptibility of 100% of the isolates. The rapid tests, unlike conventional assays, are able to provide susceptibility results within 3 days after the virus has been isolated from a clinical specimen and could thus play a direct role in therapeutic decisions.
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Affiliation(s)
- P de la Iglesia
- Laboratorio de Virología, Servicio de Microbiologia, Hospital, Asturias, Spain.
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Affiliation(s)
- S N Nader
- Department of Pediatrics, Stanford University School of Medicine, CA, USA
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Leahy BJ, Christiansen KJ, Collins P. A blinded comparison of two methods of viral susceptibility testing: plaque reduction assay versus microplate in situ ELISA. J Virol Methods 1996; 56:85-90. [PMID: 8690771 DOI: 10.1016/0166-0934(95)01957-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Viral susceptibility testing has been shown to have a role in the management of patients with herpes simplex infections. In this study, 25 isolates of herpes simplex virus representing a broad spectrum of acyclovir-susceptible and -resistant phenotypes were tested using a microplate in situ enzyme-linked immunosorbent assay (MISE). This method is objective and more rapid than the traditional plaque reduction assay (PRA). The previously derived PRA results were not known at the time of testing with the MISE method. The correlation coefficient between PRA and MISE was 0.85. Agreement on sensitive or resistant was reached for 21 of 25 isolates. The standardised microplate in situ ELISA was found to be an acceptable alternative to the plaque reduction assay.
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Affiliation(s)
- B J Leahy
- Department of Microbiology, Royal Perth Hospital, Australia
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Masci S, De Simone C, Famularo G, Gravante M, Ciancarelli M, Andreassi M, Amerio P, Santini G. Intravenous immunoglobulins suppress the recurrences of genital herpes simplex virus: a clinical and immunological study. Immunopharmacol Immunotoxicol 1995; 17:33-47. [PMID: 7759773 DOI: 10.3109/08923979509052718] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Effective treatment is not currently available for suppressing the recurrence of genital herpes simplex virus (HSV) infections. Since intravenous immunoglobulins (IVIG) proved useful against HSV in experimental models, we treated patients with very high frequency of HSV genital recurrences (more than 15 episodes per year) with IVIG (400 mg/Kg every fourth week). The control group was treated with intermittent oral acyclovir (800 mg twice a day for one week every month). Both groups were treated for six months and, then, patients were followed-up to further six months. Both IVIG and acyclovir were effective in reducing the frequency of HSV genital recurrences as compared to base-line. However, patients treated with IVIG had a more striking reduction in the frequency of recurrences as well as both a shorter mean duration and a minor severity of the lesions as compared to acyclovir-treated patients. Furthermore, we found a trend indicating IVIG as more effective in reducing the viral load. Since in IVIG-recipients we found a strong increase of peripheral blood lymphocytes with natural killer (NK) surface phenotype, we suggest that the clinical effectiveness of IVIG treatment is probably mediated via the expansion of NK cell populations. Our study indicates that the treatment with IVIG is an effective and safe tool for suppressing the recurrences of genital HSV infections.
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Affiliation(s)
- S Masci
- Clinica Dermatologica, Universita' G. D'Annunzio, Chieti, Italia
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Leahy BJ, Christiansen KJ, Shellam G. Standardisation of a microplate in situ ELISA (MISE-test) for the susceptibility testing of herpes simplex virus to acyclovir. J Virol Methods 1994; 48:93-108. [PMID: 7962265 DOI: 10.1016/0166-0934(94)90092-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Viral susceptibility testing has been traditionally performed by plaque reduction assay (PRA) which is labour intensive, time consuming and requires subjective input by the reader. An in situ enzyme-linked immunosorbent assay (ELISA) method has been developed with the potential to overcome many of the limitations of PRA, and has been applied to a variety of viruses. Previous reports of ELISA susceptibility assays have shown little standardisation between these methods, or any significant analysis of the variable factors which may influence the outcome of the assay. This study optimised the sensitivity of a microplate in situ ELISA (MISE-test) for the detection of viral growth, manipulated the interaction between cells, virus and acyclovir to determine the effect of their relationship on susceptibility results, and established standard assay conditions based on quality controlled parameters such as assay variability and linear ranges. 33 isolates of HSV-2 were tested for susceptibility to acyclovir by PRA, and the standardised MISE. Factors which were critical to the performance of the MISE included inoculum size, inoculation method, duration of incubation, fixative type, immunoglobulin working strengths and choice of chromogenic substrate. Using the ELISA it was possible to separate sensitive HSV-2 isolates from resistant isolates applying a cutoff ID50 value of 2.0 mg/l. The correlation coefficient between PRA and MISE was 0.65. The standardised microplate in situ ELISA was found to be an acceptable alternative to the plaque reduction assay.
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Affiliation(s)
- B J Leahy
- Department of Microbiology, Royal Perth Hospital, Australia
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Kost RG, Hill EL, Tigges M, Straus SE. Brief report: recurrent acyclovir-resistant genital herpes in an immunocompetent patient. N Engl J Med 1993; 329:1777-82. [PMID: 8232486 DOI: 10.1056/nejm199312093292405] [Citation(s) in RCA: 126] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- R G Kost
- Medical Virology Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md. 20892
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12
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Abstract
Oral and intravenous acyclovir formulations provide effective virostasis against many herpes viruses infections, especially severe herpes simplex or varicella-zoster infections in ambulatory and immunocompromised patients. The therapeutic virostatic efficacy of topical acyclovir formulations requires further development, however, especially for orolabial herpetic infections.
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Affiliation(s)
- C L Lavelle
- University of Manitoba, Department of Oral Biology, Winnipeg, Canada
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13
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Hill EL, Hunter GA, Ellis MN. In vitro and in vivo characterization of herpes simplex virus clinical isolates recovered from patients infected with human immunodeficiency virus. Antimicrob Agents Chemother 1991; 35:2322-8. [PMID: 1666496 PMCID: PMC245379 DOI: 10.1128/aac.35.11.2322] [Citation(s) in RCA: 97] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A total of 100 herpes simplex viruses isolated from lesions not responding to acyclovir (ACV) therapy were recovered from 51 patients infected with human immunodeficiency virus. In vitro analysis of these isolates included testing their susceptibility to ACV and determining their thymidine kinase (TK) phenotypes. Of the 100 isolates evaluated, 23 were ACV sensitive and 77 were ACV resistant. Seventy-four of these ACV-resistant isolates were of the TK-deficient or low-TK-producer phenotype and three were of the TK-altered phenotype. The TKs isolates that represented each of the different autoradiographic phenotypes were further characterized by enzyme kinetics. The ability of selected isolates to cause disease in vivo was evaluated by using several mouse virulence models. Cutaneous virulence in normal and immunocompromised mice was evaluated, and neurovirulence in normal mice was determined. Latent infections were assayed by the cocultivation of trigeminal ganglia recovered from mice that had survived acute infection. These reactivated viruses were evaluated in vitro and compared with the original infecting isolate. The mechanisms of resistance and pathogenicity of these herpes simplex virus isolates recovered from patients positive for human immunodeficiency virus are similar to those reported for isolates recovered from normal and immunocompromised patients without AIDS.
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Affiliation(s)
- E L Hill
- Division of Virology, Burroughs Wellcome Co., Research Triangle Park, North Carolina 27707
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Epstein JB, Scully C. Herpes simplex virus in immunocompromised patients: growing evidence of drug resistance. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1991; 72:47-50. [PMID: 1653925 DOI: 10.1016/0030-4220(91)90188-i] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Antiviral drugs have proven effective in treatment of herpesvirus infections and in prevention of reactivation of latent virus. The prototype drug is acyclovir. Herpes simplex virus (HSV) is susceptible to acyclovir. There is increasing evidence in immunocompromised patients of acyclovir-resistant HSV causing clinical disease. Mechanisms of HSV resistance to acyclovir are known. These findings have implications for the future development and clinical use of antiviral drugs.
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Affiliation(s)
- J B Epstein
- Cancer Control Agency of British Columbia, Vancouver, Canada
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Menage MJ, de Clercq E, van Lierde A, Easty VS, Darville JM, Cook SD, Easty DL. Antiviral drug sensitivity in ocular herpes simplex virus infection. Br J Ophthalmol 1990; 74:532-5. [PMID: 2168202 PMCID: PMC1042201 DOI: 10.1136/bjo.74.9.532] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Thirty-nine herpes simplex virus (HSV) isolates were assayed for their sensitivity to 10 different antiviral agents. Of these 39 HSV isolates 10 were cultured from recipient buttons obtained at penetrating keratoplasty in patients with inactive stromal scarring due to recurrent herpetic keratitis, 25 were cultured from patients with conjunctival and ulcerative ocular infections, and the remaining four were laboratory strains with known drug sensitivity patterns, thus providing controls for the experiment. All but one of the 35 clinical isolates of HSV were type 1 and all were sensitive to the 10 antiviral agents. A single type 2 isolate from a young man with recurrent conjunctivitis proved to be resistant to a number of the antiviral agents. Since many of the clinical isolates had been exposed to multiple and protracted antiviral drug treatment, it is suggested that antiviral drug resistance in type 1 HSV ocular infection is not a significant problem.
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Affiliation(s)
- M J Menage
- Department of Ophthalmology, Bristol Eye Hospital
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Bamborschke S, Porr A, Huber M, Heiss WD. Demonstration of herpes simplex virus DNA in CSF cells by in situ hybridization for early diagnosis of herpes encephalitis. J Neurol 1990; 237:73-6. [PMID: 2162383 DOI: 10.1007/bf00314664] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Herpes simplex virus (HSV) was studied by in situ DNA hybridization with a biotinylated cDNA probe in 56 air-dried methanol-fixed cerebrospinal fluid (CSF) cell preparations which had been collected from 12 patients with herpes simplex encephalitis (HSE) during the previous 5 years. In three additional HSE cases, freshly prepared acetone-fixed CSF cell preparations were available. In all cases, CSF cell preparations were obtained by cytocentrifugation. Herpes simplex virus DNA could be demonstrated in 8 of the 12 HSE cases with methanol-fixed cells (66%) and in all 3 cases with fresh acetone-fixed CSF cells. The earliest CSF sample was available at the onset of symptoms and showed positive DNA hybridization. In three cases hybridization was positive after a clinical course of more than 5 weeks but was usually found in the 1st week of illness before the beginning of specific inthrathecal IgG synthesis. In 54 control cases with other acute inflammatory diseases of the CNS, including 14 cases of varicella-zoster meningitis, no positive hybridization was detected. These findings strongly suggest that in situ hybridization in CSF cells is a reliable tool for the early and rapid diagnosis of HSE, especially at the onset of the disease, when no antibodies can be detected.
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Affiliation(s)
- S Bamborschke
- Klinik und Poliklinik für Neurologie und Psychiatrie der Universität zu Köln, Federal Republic of Germany
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Balfour HH, Kelly JM, Suarez CS, Heussner RC, Englund JA, Crane DD, McGuirt PV, Clemmer AF, Aeppli DM. Acyclovir treatment of varicella in otherwise healthy children. J Pediatr 1990; 116:633-9. [PMID: 2156984 DOI: 10.1016/s0022-3476(05)81618-x] [Citation(s) in RCA: 134] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
STUDY OBJECTIVE To determine whether acyclovir administered orally affects the duration and severity of varicella in otherwise normal children. DESIGN Randomized, placebo-controlled, double-blind trial. SETTING Patients' residence and university hospital clinic. PATIENTS One hundred five children between 5 and 16 years of age with laboratory-confirmed varicella entered the study. Of the 102 who were included in the final analysis, 50 received acyclovir and 52 received placebo. INTERVENTION Placebo or acyclovir was given orally four times daily, for 5 to 7 days. The acyclovir dose was adjusted as follows: 5 to 7 years of age, 20 mg/kg; 7 to 12 years, 15 mg/kg; and 12 to 16 years, 10 mg/kg. MEASUREMENTS AND MAIN RESULTS Acyclovir recipients, compared with the placebo group, defervesced sooner (median, 1 day vs 2 days; p = 0.001), experienced onset of cutaneous healing sooner, as reflected by a decrease in number of lesions (median, 3 days vs 2 days; p = 0.002), and had fewer skin lesions (median, 500 vs 336; p = 0.02). Acyclovir did not significantly change the rate of complications of varicella (10% in the acyclovir group vs 13.5% among placebo subjects). Adverse drug effects were not observed. Acyclovir recipients had lower geometric mean serum antibody titers to varicella-zoster virus than their placebo counterparts 4 weeks after the onset of illness, but antibody titers in both groups were similar 1 year later. CONCLUSIONS These results provide evidence that acyclovir is useful and well tolerated for treatment of varicella in otherwise healthy children.
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Affiliation(s)
- H H Balfour
- Department of Laboratory Medicine and Pathology, University of Minnesota Health Sciences Center, Minneapolis 55455
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Fletcher CV, Englund JA, Bean B, Chinnock B, Brundage DM, Balfour HH. Continuous infusion of high-dose acyclovir for serious herpesvirus infections. Antimicrob Agents Chemother 1989; 33:1375-8. [PMID: 2552909 PMCID: PMC172658 DOI: 10.1128/aac.33.8.1375] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Thirteen patients with herpesvirus infections who were unresponsive to at least 72 h of intermittent acyclovir administration received high-dose continuous infusion. Steady-state concentrations were maintained at between 20 and 98 mumol/liter. Of 12 patients who had continuous infusion for greater than 5 days, 7 (58%) resolved their infections, as determined by clinical and virologic parameters, suggesting that continuous infusion may succeed in some patients who do not respond to conventional therapy.
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Affiliation(s)
- C V Fletcher
- Department of Pharmacy Practice, University of Minnesota, Health Sciences Center, Minneapolis 55455
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Oliver NM, Collins P, Van der Meer J, Van't Wout JW. Biological and biochemical characterization of clinical isolates of herpes simplex virus type 2 resistant to acyclovir. Antimicrob Agents Chemother 1989; 33:635-40. [PMID: 2546486 PMCID: PMC172504 DOI: 10.1128/aac.33.5.635] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A series of clinical isolates of herpes simplex virus type 2 were taken from a patient with chronic lymphocytic leukemia. Acyclovir (ACV) susceptibility assays revealed that some isolates were resistant to ACV and cross-resistant to ganciclovir but not to phosphonoacetic acid. The nature of the resistance was examined further. A number of cloned variants were generated, and thymidine kinase and DNA polymerase assays were carried out. Variants that were resistant to ACV were found to be thymidine kinase deficient. Evidence for alteration in the DNA polymerase was not found when ACV triphosphate or phosphonoacetic acid was used as the inhibitor. In vivo studies with the plaque-purified viruses showed that ACV resistance was associated with a reduced neurovirulence. In a zosteriform model, virus resistant to ACV was unable to induce secondary spread in the same dermatome, to invade the peripheral nervous system or the central nervous system, or to establish latent infections.
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Affiliation(s)
- N M Oliver
- Department of Molecular Sciences, Wellcome Research Laboratories, Beckenham, Kent, England
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MacPhail LA, Greenspan D, Schiødt M, Drennan DP, Mills J. Acyclovir-resistant, foscarnet-sensitive oral herpes simplex type 2 lesion in a patient with AIDS. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1989; 67:427-32. [PMID: 2524706 DOI: 10.1016/0030-4220(89)90386-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We report the case of an immunocompromised patient with AIDS in whom developed a perioral and several intraoral HSV 2 lesions that persisted for more than 1 year. The virus was resistant to acyclovir but was sensitive to foscarnet. Viral isolates were thymidine kinase negative. The lesions resolved with intravenous foscarnet therapy given over a 15-week period, and when last seen, 8 months after foscarnet was discontinued, the patient had not had a recurrence.
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21
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Abstract
Ocular herpes simplex disease has a variable pattern of manifestations and recurrences as a result of the site and extent of the infection, the host immunologic events, the trophic damage within ocular tissues, and the toxic effects of antiviral medications. Laboratory research has established a clinical model and a working hypothesis about the complex pathophysiologic features of the disease and the interaction of the virus with its host tissue. Recent studies have further defined the viral genome and its role in virulence and pathogenicity. Antiviral therapy is effective in some but not all aspects of the ocular infection. A proposed clinical classification of ocular herpes simplex is based on the manifestations associated with viral disease and those associated with the host response and the subsequent structural damage. A plan for medical and surgical management of ocular herpes simplex, based on current knowledge of the disease process, relates to the integrity of the epithelium and the presence of active viral disease.
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Affiliation(s)
- T J Liesegang
- Department of Ophthalmology, Mayo Clinic Jacksonville, FL 32224
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22
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Abstract
The genome of herpes simplex virus codes for several enzymes, including viral thymidine kinase and viral deoxyribonucleic acid (DNA) polymerase. When viral resistance develops, it does so by changes in these two enzymes. Three possible mechanisms of viral resistance to acyclovir include (1) selection of viral mutants that make little or no thymidine kinase and do not phosphorylate acyclovir adequately, (2) selection of mutants that can phosphorylate thymidine but cannot phosphorylate acyclovir (i.e., these viruses have thymidine kinases with altered substrate specificity), and (3) selection of viruses that have altered DNA polymerases that replicate viral DNA in the presence of acyclovir triphosphate. Thymidine kinase-deficient virus has been isolated from clinical isolates frequently, but few strains appear to be virulent for animals or humans and only a few seem to have caused clinical disease. Viruses with altered substrate specificity have been reported but viruses with an altered DNA polymerase have not occurred in clinical practice. Antiviral drugs should be used only when necessary to minimize the appearance of resistant strains of virus.
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Affiliation(s)
- C S Crumpacker
- Department of Medicine, Harvard Medical School, Boston, MA
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23
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Abstract
Amantadine is well established as the preferred antiviral agent for the prophylaxis of influenza A and may also be beneficial therapeutically when used early in the course of the disease. Idoxuridine is applicable only in the treatment of herpetic keratitis. Currently, acyclovir is the most effective agent for the treatment of herpes simplex and varicella-zoster virus infections. Ribavirin has recently been released for use in aerosol form for severe respiratory syncytial virus infections that occur in infants and young children. Vidarabine, which previously was the drug of choice in the treatment of severe herpetic infections, has now been replaced by the more effective acyclovir. Ganciclovir, an experimental agent, has shown promise against cytomegalovirus infections in patients who have undergone kidney or liver transplantation, but its effects are only temporary in patients who have undergone bone marrow transplantation and patients with acquired immunodeficiency syndrome (AIDS) who have cytomegalovirus infections.
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Affiliation(s)
- P E Hermans
- Division of Infectious Diseases and Internal Medicine, Mayo Clinic, Jacksonville, Florida
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24
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26
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Kit S, Sheppard M, Ichimura H, Nusinoff-Lehrman S, Ellis MN, Fyfe JA, Otsuka H. Nucleotide sequence changes in thymidine kinase gene of herpes simplex virus type 2 clones from an isolate of a patient treated with acyclovir. Antimicrob Agents Chemother 1987; 31:1483-90. [PMID: 2829709 PMCID: PMC174976 DOI: 10.1128/aac.31.10.1483] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
To identify the nucleotide changes that occur in drug-induced thymidine kinase (TK) mutants of herpes simplex virus type 2 (HSV-2), we compared the nucleotide sequences of the tk genes of two mutant HSV-2 clones isolated from a patient who had been treated with acyclovir [9-(2-hydroxyethoxymethyl)guanine; ACV] with the nucleotide sequence of the parental TK+ HSV-2(8703) strain isolated from the same patient. One of the mutants, TK-altered (TKA) HSV-2(9637), was ACV resistant but induced the incorporation of [14C]thymidine into the DNA of infected rabbit skin cells. The nucleotide sequence of the tk gene of mutant TKA HSV-2(9637) had a single change (G to A) at nucleotide 668, which would cause an arginine-to-histidine substitution at amino acid residue 223 of the TK polypeptide. The second ACV-resistant mutant, TK- HSV-2(8710), did not induce detectable incorporation of [14C]thymidine into the DNA of infected rabbit skin cells. This mutant exhibited a deletion of a single base at nucleotide 217 of its nucleotide sequence. This deletion would cause a frameshift mutation at amino acid residue 73 and chain termination at amino acid residue 86 of the TK polypeptide. The nucleotide sequence of TK+ HSV-2(8703) was the same as that of the laboratory strain, TK+ HSV-2(333). The nucleotide sequence of a bromodeoxyuridine-resistant TK- HSV-2(333) mutant of TK+ HSV-2(333) also exhibited a single-base deletion, but at nucleotide 439. This deletion would cause a frameshift mutation at amino acid residue 147 and chain termination at amino acid residue 182. The frameshift mutations of TK- HSV(8710) and TK- HSV-2(333), respectively, occurred in sequences in which C was repeated three times and G was repeated seven times. The results raise the possibility that TK- frameshift mutations of HSV-2 may be common.
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Affiliation(s)
- S Kit
- Division of Biochemical Virology, Baylor College of Medicine, Houston, Texas 77030
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27
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Bean B, Fletcher C, Englund J, Lehrman SN, Ellis MN. 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; 7:199-204. [PMID: 2820649 DOI: 10.1016/0732-8893(87)90005-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Rapidly progressive disease due to acyclovir-resistant herpes simplex has not been described. We report such a case and detail successful patient management using viral sensitivities and plasma acyclovir levels to guide therapy. Response was correlated with plasma levels above those inhibiting viral growth by 50% (ID50) in vitro.
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Affiliation(s)
- B Bean
- Department of Laboratory Medicine and Pathology, University of Minnesota Health Sciences Center, Minneapolis
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28
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Abstract
ACV is an effective agent for the treatment and prophylaxis of HSV infections in both IC and immunologically normal individuals. The drug is well tolerated in both populations and is not significantly associated with clinical or laboratory toxicities. Because of the great potential benefit and low risk, organ transplant recipients and patients with hematologic malignancies undergoing induction chemotherapy should be screened routinely for HSV antibodies; seropositive individuals should receive prophylactic ACV during the period of most profound immunosuppression. Immunologically normal individuals with frequently recurring genital HSV or serious complications associated with outbreaks are candidates for long-term suppression with ACV.
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29
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Friedman-Kien AE, Klein RJ, Glaser RD, Czelusniak SM. Treatment of recurrent genital herpes with topical alpha interferon gel combined with nonoxynol 9. J Am Acad Dermatol 1986; 15:989-94. [PMID: 3023457 DOI: 10.1016/s0190-9622(86)70262-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A double-blind, placebo-controlled study was done to evaluate the efficacy of an alpha interferon preparation in 128 patients with recurrent genital herpes. The preparation containing 10(5) or 10(7) U alpha interferon with nonoxynol 9 in a cream base (Exovir-HZ) was applied three times daily for 5 days. The treatment did not cause any adverse reactions. Patients treated with either interferon concentration became negative for viral culture at a faster rate than placebo recipients. The end of new lesion formation, scabbing, and the healing of lesions were all superior in patients treated with 10(5) U to those treated with 10(7) U interferon. End of new lesion formation and scabbing were also statistically different in patients treated with 10(7) U from those patients treated with placebo. Results suggest that topical interferon might be useful in relieving symptoms of severe cases of genital herpes.
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30
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Harmenberg J, Sundqvist VA, Gadler H, Levén B, Brännström G, Wahren B. Comparative methods for detection of thymidine kinase-deficient herpes simplex virus type 1 strains. Antimicrob Agents Chemother 1986; 30:570-3. [PMID: 3024561 PMCID: PMC176482 DOI: 10.1128/aac.30.4.570] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Four methods for analyzing viral susceptibility to antiviral substances were compared. In two methods viral products were measured: late viral proteins were measured by an enzyme-linked immunosorbent assay and viral DNA was measured by DNA hybridization. Infectious virus was quantified in the other two assays as the number of plaques and the yield of virus. The enzyme-linked immunosorbent assay procedure in our hands detected the smallest amounts (lowest proportions) of thymidine kinase-deficient herpes simplex virus type 1 mixed with wild-type virus. The thymidine kinase-deficient proportion of the herpes simplex virus type 1 isolate increased rapidly in the presence of acyclovir in cell culture.
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31
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Langlois M, Allard JP, Nugier F, Aymard M. A rapid and automated colorimetric assay for evaluating the sensitivity of herpes simplex strains to antiviral drugs. JOURNAL OF BIOLOGICAL STANDARDIZATION 1986; 14:201-11. [PMID: 3020058 DOI: 10.1016/0092-1157(86)90004-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A rapid and sensitive colorimetric assay has been developed to evaluate the sensitivity of herpes simplex viruses (HSV) to antiviral agents. The chessboard titration of viruses and antiviral drugs and the automatic reading and analysis of the data allows objective and accurate results to be rapidly obtained. Virus sensitivity was expressed as an ED50 value which was the concentration of drug (micrograms/ml) reducing viral cpe by 50%. The ED50 values of antiviral drugs [acetylguanosine (ACV), idoxuridine (IDU), deoxycytidine (IDC) and bromovinyl deoxyuridine] for several HSV reference strains were determined and the method was then applied to clinical specimens. The selection of ACV and IDU resistant mutants was performed on a cloned sensitive HSV 1 ocular strain. We observed cross-resistance between ACV and IDU for the mutants isolated. The resistance to thymidine-kinase-dependent antiviral agents varied in inverse ratio to the thymidine kinase activity induced by HSV strains.
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32
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Ehninger G, Vallbracht A, Schüch K, Kumbier I, Dopfer R, Schmidt H, Ostendorf P. [Oral prophylaxis of herpes infections using acyclovir following bone marrow transplantation: a clinical and clinico-pharmacological study]. KLINISCHE WOCHENSCHRIFT 1986; 64:570-4. [PMID: 2426515 DOI: 10.1007/bf01735321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
Viral infections are one of the major complications after bone marrow transplantation, with high mortality and morbidity. Fourty-six patients between 3 and 48 years old (median 15 years) received orally 400 mg (under age 6, 200 mg) acyclovir 4 times daily from day -12 before to day 84 after BMT. All patients were isolated in laminar-airflow units for at least 23 days with total enteral decontamination. They were concomitantly treated with anti-CMV-hyperimmunoglobulin and cotrimoxazol. During acyclovir prophylaxis seven patients had herpes simplex virus infections, all of them were seropositive before BMT. Acyclovir plasma concentrations were measured by use of a new HPLC method. No acyclovir was present (detection limit 40 ng/ml) in the plasma of five out of six patients with HSV infections. Three of them had non-compliance, and a lack of acyclovir absorption developed in two patients under conditioning regimen. No drug-related side effects were observed. Laboratory tests did not show liver or renal toxicity. Take and hematologic reconstitution were unchanged. In our study, oral acyclovir reduced the incidence of herpes simplex infections after bone marrow transplantation. Herpes infections only occurred in patients with non-compliance or lack of acyclovir absorption.
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33
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McLaren C, Chen MS, Ghazzouli I, Saral R, Burns WH. Drug resistance patterns of herpes simplex virus isolates from patients treated with acyclovir. Antimicrob Agents Chemother 1985; 28:740-4. [PMID: 3002245 PMCID: PMC180320 DOI: 10.1128/aac.28.6.740] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A decrease in the in vitro sensitivity to acyclovir (ACV) was observed in successive isolates of herpes simplex virus type 1 from three immunocompromised patients during intravenous therapy with this drug. The ACV-resistant isolate from patient 1 was cross-resistant to dihydroxypropoxymethylguanine and bromovinyldeoxyuridine, but still susceptible to three fluoro-substituted pyrimidines, 2'-fluoro-5-iodo-1-beta-D-arabinofuranosylcytosine (FIAC), 2'-fluoro-5-iodo-1-beta-D-arabinofuranosyluracil (FIAU), and 2'-fluoro-5-iodo-1-beta-D-arabinofuranosylthymine (FMAU). The thymidine kinase (TK) from the resistant isolate showed a 50-fold or greater reduction in affinity for thymidine, FIAU, FMAU, and ACV, but the total enzyme activity was similar to that of the sensitive isolate. The ACV-resistant isolate from patient 2 was also resistant to dihydroxypropoxymethylguanine, bromovinyldeoxyuridine, and the fluoro-substituted compounds; TK activity for this isolate was less than 1% of the patient's pretherapy isolate. An isolate obtained during a subsequent recurrence in patient 2 was susceptible to ACV and the other TK-dependent agents. The ACV-resistant isolate from patient 3 was partially resistant to FIAC and FIAU but still susceptible to FMAU; the viral TK had a 10-fold-lower affinity for ACV, FIAU, and FMAU than did the sensitive pretherapy isolate, while the level of TK activity detected was reduced to 6%. In none of the isolates studied was a change in sensitivity to phosphonoformic acid observed. Compared with the corresponding pretherapy ACV-sensitive isolates, there was a 30-fold decrease in neurovirulence for mice of the two drug-resistant isolates with diminished levels of thymidine-phosphorylating activity and no change in virulence for the third isolate. These findings indicate that mixed patterns of drug-resistance to TK-dependent antiviral compounds can occur in clinical isolates, resulting from changes in either the amount or the affinity of viral TK activity.
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34
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Crowe S, Mills J. Chemotherapy of herpesvirus infections: present successes and future hopes. EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY 1985; 4:459-63. [PMID: 2998787 DOI: 10.1007/bf02014424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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35
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Vilde J, Bricaire F, Leport C. La chimiothérapie antivirale chez l'immunodéprimé : résultats et indications actuels. Med Mal Infect 1985. [DOI: 10.1016/s0399-077x(85)80302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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36
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Selby P, Powles RL, Blake S, Stolle K, Mbidde EK, McElwain TJ, Hickmott E, Whiteman PD. Amino (hydroxyethoxymethyl) purine: a new well-absorbed prodrug of acyclovir. Lancet 1984; 2:1428-30. [PMID: 6151046 DOI: 10.1016/s0140-6736(84)91624-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Acyclovir is an effective treatment for herpes simplex and herpes zoster infections, but it is somewhat limited by low oral absorption. 2-amino-9-[(2hydroxyethoxy)methyl]-9H-purine (BW A515U), a new prodrug of acyclovir, when evaluated in 10 patients with haematological malignancies, was well tolerated, excellently absorbed, and produced high plasma concentrations of acyclovir which were comparable to those with intravenous acyclovir. The plasma concentrations after oral BW A515U were much higher than those after oral acyclovir.
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37
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Straus SE, Takiff HE, Seidlin M, Bachrach S, Lininger L, DiGiovanna JJ, Western KA, Smith HA, Lehrman SN, Creagh-Kirk T. Suppression of frequently recurring genital herpes. A placebo-controlled double-blind trial of oral acyclovir. N Engl J Med 1984; 310:1545-50. [PMID: 6328297 DOI: 10.1056/nejm198406143102401] [Citation(s) in RCA: 234] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We studied 35 otherwise healthy adults with frequently recurring genital herpes (greater than or equal to 1 episode per month), in a double-blind trial comparing oral acyclovir with placebo capsules for suppression of recurrent infection. The patients were treated for 125 days unless herpes recurred. Among 32 evaluable patients, there were significantly fewer recurrences during acyclovir treatment (4 of 16) than during placebo treatment (16 of 16, P less than 0.001). The mean duration of therapy was significantly longer for patients receiving acyclovir than for those receiving placebo (114.9 vs. 24.8 days, P less than 0.001). Of 19 patients who had recurrences in the blind trial, only 2 had recurrences when given acyclovir in a second, open-study phase. All patients had recurrences after completing acyclovir treatment. The therapy was well tolerated, with minimal gastrointestinal upset and one hypersensitivity reaction. Studies of the viral isolates demonstrated that lesions developing in patients receiving acyclovir contained drug-resistant virus. Later recurrences in these patients were associated with drug-sensitive virus. We conclude that oral acyclovir suppresses genital herpes in patients with frequent recurrences, but the potential for problems with drug resistance and the long-term safety need to be more fully explored.
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38
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Fiddian AP, Brigden D, Yeo JM, Hickmott EA. Acyclovir: an update of the clinical applications of this antiherpes agent. Antiviral Res 1984; 4:99-117. [PMID: 6089659 DOI: 10.1016/0166-3542(84)90011-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This paper reviews the clinical evaluation of acyclovir in the treatment of herpes-virus infections, predominantly those due to herpes simplex and varicella-zoster viruses. Intravenous, oral and topical acyclovir have been reported to be effective in the therapy of a wide variety of established herpes simplex virus infections and the systemic drug has been shown to be capable of suppressing reactivation of that virus. Although acyclovir has less activity against varicella-zoster virus, infections caused by this agent are also susceptible to intravenous and possibly oral therapy. Clinical efficacy against Epstein-Barr virus and cytomegalovirus infections has not been demonstrated but several studies are currently in progress. Limited evidence of in vivo activity against hepatitis B virus also requires further evaluation. Continued studies on tolerance of the drug in clinical use has confirmed the early promise of this selective antiviral, whilst initial concern about the development of widespread resistance has not been borne out in practice.
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39
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40
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de Clercq E. Antiherpes drugs: promises and pitfalls. EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY 1984; 3:96-107. [PMID: 6327297 DOI: 10.1007/bf02014325] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In recent years several selective antiherpes drugs have been developed which all show great promise for the systemic and topical treatment of herpes simplex virus and varicella-zoster virus infections. These new antiherpes agents include acyclovir, bromovinyldeoxyuridine, fluoroiodoaracytosine and phosphonoformate. Acyclovir has already been licensed for both topical and systemic use, and it is expected that other compounds will follow soon. Although this new generation of antiherpes drugs suffer from some drawbacks, i.e. narrow spectrum of activity, inefficacy during virus latency, and the possible emergence of drug-resistant virus strains, these limitations by no means outweigh the potentials of these drugs in the therapy and prophylaxis of herpesvirus infections in humans.
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41
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Field HJ, Lay E. Characterization of latent infections in mice inoculated with herpes simplex virus which is clinically resistant to acyclovir. Antiviral Res 1984; 4:43-52. [PMID: 6331304 DOI: 10.1016/0166-3542(84)90024-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Mice were inoculated into the ear pinna with herpes simplex virus (HSV) using a strain which is resistant to acyclovir (ACV) chemotherapy. The original inoculum was resistant to ACV because it contained a proportion of thymidine kinase-defective (TK-) virions. This had been obtained previously by passage of an HSV type 1 strain in mice undergoing suboptimal therapy. The cervical dorsal root ganglia were subsequently explanted from the infected mice and the presence of latent virus therein revealed by reactivation in vitro. These explant cultures yielded both TK+ and TK- viruses on reactivation. The establishment of latent infections was not affected by chemotherapy during the acute infection. One TK- ganglion isolate when studied in detail was found to be attenuated and thus resembled previously examined TK- strains which had been selected in vitro for ACV-resistance.
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