SUCCESSFUL TREATMENT OF PROGRESSIVE MUCOCUTANEOUS INFECTION DUE TO ACYCLOVIR-RESISTANT AND FOSCARNET-RESISTANT HERPES-SIMPLEX VIRUS WITH S)-1-(3-HYDROXY-2-PHOSPHONYLMETHOXYPROPYL)CYTOSINE (HPMPC)

The acyclic nucleoside phosphonate S)-1-(3-hydroxy-2-phosphonylmethoxy propyl)cytosine (HPMPC) was used topically for the treatment of persis tent mucocutaneous infections in two cases. One patient with AIDS suff ered from a perineal lesion due to infection with herpes simplex virus type 2 (HSV-2) and did not respond to acyclovir and was intolerant of foscarnet. A bone marrow transplant recipient developed orofacial les ions due to infection with herpes simplex virus type 1 (HSV-1) that fa iled to respond to therapy with both acyclovir and foscarnet. After to pical application of HPMPC, the HSV-2 lesions completely resolved. How ever, the lesions recurred 3 weeks later, and, upon subsequent treatme nt with HPMPC, regressed. On recurrence, the virus was found to be sen sitive to acyclovir, which the patient was given. Again HSV-2, which w as resistant to acyclovir, emerged; similar observations were made aft er another cycle of HPMPC therapy. The HSV-1 isolates were resistant t o acyclovir and foscarnet. Following local HPMPC treatment, the lesion s regressed, but after 1 week, a second course of topical HPMPC therap y had to be instituted for recurrent infection. The lesions again regr essed, and as the recurrent virus was sensitive to acyclovir, the pati ent was successfully treated with the drug. The results of this study point to the potential usefulness of topical HPMPC in the treatment of immunocompromised patients with HSV-related mucocutaneous infections that are refractory to therapy with acyclovir and/or foscarnet.