TREATMENT WITH INTRAVENOUS -1-[3-HYDROXY-2-(PHOSPHONYLMETHOXY)PROPYL]CYTOSINE OF ACYCLOVIR-RESISTANT MUCOCUTANEOUS INFECTION WITH HERPES-SIMPLEX VIRUS IN A PATIENT WITH AIDS

)1-[3-hydroxy-2-(phosphonylmethoxy)propyl]cytosine (HPMPC) is a nucleo tide analogue with potent in vitro and in vivo activity against a broa d range of herpesviruses, including acyclovir-resistant herpes simplex virus (HSV). A patient with severe acyclovir-resistant perineal HSV i nfection received intravenous HPMPC at 5 mg/kg/week, with concomitant oral probenecid and prehydration, and had 95% healing after four infus ions. The patient developed a hypersensitivity reaction to probenecid and discontinued HPMPC after the fourth infusion. Recurrence of the pe rineal lesions 2 weeks later prompted initiation of an oral desensitiz ation program to probenecid and enabled the patient to resume therapy. The lesions again responded to infusions of HPMPC, but the drug was d iscontinued before complete healing because of transient nephrotoxicit y (proteinuria, 2+; creatinine, 1.7 mg/dL). HPMPC is a potent antivira l agent that holds promise as a potential treatment for acyclovir-resi stant HSV infection.