Resistance to antiviral drugs in herpes simplex virus infections among allogeneic stem cell transplant recipients: Risk factors and prognostic significance
S. Chakrabarti et al., Resistance to antiviral drugs in herpes simplex virus infections among allogeneic stem cell transplant recipients: Risk factors and prognostic significance, J INFEC DIS, 181(6), 2000, pp. 2055-2058
Herpes simplex virus (HSV) infections in 75 allogeneic stem cell transplant
recipients were analyzed. Sixteen patients developed HSV disease following
transplantation. The risk factors were age, sex (females), unrelated donor
graft, and graft-versus-host disease (GVHD) grade greater than or equal to
2. Seven patients did not respond to acyclovir, and 3 patients failed to r
espond to foscarnet, Isolates from 4 patients developed resistance to acycl
ovir/penciclovir, and 3 patients had foscarnet-resist ant isolates. The rem
aining 3 patients failed to respond to acyclovir, despite having sensitive
isolates. All the isolates were sensitive to cidofovir, for which the IC50
values correlated inversely with those for acyclovir (P = .01). The risk fa
ctors for clinical resistance to antiviral drugs were a GVHD grade greater
than or equal to 2 (P = .001) and the lack of ganciclovir prophylaxis (P =
.01), with a higher nonrelapse mortality in the latter group (P < .0001). C
linical as well as in vitro resistance to antiviral drugs is common in pati
ents with severe GVHD and is associated with a poor outcome.