MANAGEMENT OF ACYCLOVIR-RESISTANT HERPES-SIMPLEX AND VARICELLA-ZOSTERVIRUS-INFECTIONS

Persons with AIDS who have CD4(+) counts less than or equal to 100 and transplant patients, especially bone marrow allograft recipients, may experience clinically significant infections with acyclovir-resistant herpes simplex virus (HSV) or varicella-zoster virus (VZV). Patients who have received prior repeated acyclovir treatment appear to be at t he highest risk of harboring acyclovir-resistant strains. Algorithms f or the management of these infections were developed at a recent round table symposium. The consensus of the panelists was that treatment wit h foscarnet should be initiated within 7-10 days in patients suspected to have acyclovir-resistant HSV or VZV infections. Foscarnet therapy should be continued for at least 10 days or until lesions are complete ly healed. Recurrences may respond to either foscarnet or, occasionall y, acyclovir.