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Herpes Simplex Virus Resistant to Acyclovir: A Study in a Tertiary Care Center

Janet A. Englund, MD; Mark E. Zimmerman, BS; Ella M. Swierkosz, PhD; Jesse L. Goodman, MD; David R. Scholl, PhD; and Henry H. Balfour Jr., MD
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Presented in part at the annual meeting of the American Society of Pediatrics, Washington, DC, 1988, and at the Fourth International AIDS Conference, Stockholm, Sweden, June 1988.

Grant Support: By grants AI 27661, AM 13083, and CA 21737 from the National Institutes of Health and by a grant from the Minnesota Medical Foundation.

Requests for Reprints: Janet A. Englund, MD, Influenza Research Center, Baylor College of Medicine, Texas Medical Center, Houston, TX 77030.

Current Author Addresses: Dr. Englund: Influenza Research Center, Baylor College of Medicine, Texas Medical Center, Houston, TX 77030. Mr. Zimmerman and Dr. Balfour, Jr.: Department of Laboratory Medicine and Pathology, University of Minnesota Health Sciences Center, Minneapolis, MN 55455.

Dr. Goodman: Department of Medicine, University of Minnesota Health Sciences Center, Minneapolis, MN 55455.

Dr. Swierkosz: Cardinal Glennin Children's Hospital, 1465 South Grande Boulevard, St. Louis, MO 63104.

Dr. Scholl: Diagnostic Hybrids, Inc., One President Street, Athens, OH 45701.

©1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;112(6):416-422. doi:10.7326/0003-4819-76-3-112-6-416
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Study Objective: To determine the sensitivity of herpes simplex virus isolates to acyclovir and the importance of resistant isolates in hospitalized patients.

Design: Retrospective incidence cohort study.

Setting: All herpes simplex virus isolates cultured over 1 year from patients followed at a tertiary care center.

Patients: Consecutive herpes simplex virus isolates were collected from 207 patients, including immunocompetent patients, patients with malignancy, neonates, bone marrow and organ transplant recipients, and patients seropositive for human immunodeficiency virus.

Measurements and Main Results: A rapid nucleic acid hybridization method was used to assess susceptibility to acyclovir. Acyclovir-resistant herpes simplex viruses were recovered from 7 of 148 immunocompromised patients (4.7%) but from none of 59 immunocompetent hosts. Clinical disease was found in all 7 patients with resistant herpes simplex virus and was more severe in pediatric patients. All resistant isolates were from acyclovir-treated patients and had absent or altered thymidine kinase activity by plaque autoradiography.

Conclusion: Herpes simplex virus resistant to acyclovir arises relatively frequently in immunocompromised patients and may cause serious disease. Rapid detection of resistance permits antiviral therapy to be individualized. Antiviral susceptibility testing to monitor viral resistance should be encouraged, especially in tertiary care settings.





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