Chen Y, Scieux C, Garrait V, Socié G, Rocha V, Molina J M, Thouvenot D, Morfin F, Hocqueloux L, Garderet L, Espérou H, Sélimi F, Devergie A, Leleu G, Aymard M, Morinet F, Gluckman E, Ribaud P
Service d'Hématologie-Greffe de Moelle, Hôpital Saint-Louis, Paris, France.
Clin Infect Dis. 2000 Oct;31(4):927-35. doi: 10.1086/314052. Epub 2000 Oct 10.
Fourteen cases of severe acyclovir-resistant herpes simplex virus type 1 (HSV-1) infection, 7 of which showed resistance to foscarnet, were diagnosed among 196 allogeneic stem cell transplant recipients within a 29-month period. Recipients of unrelated stem cell transplants were at higher risk. All patients received foscarnet; 8 subsequently received cidofovir. Strains were initially foscarnet-resistant in 3 patients and secondarily so in 4 patients. In vitro resistance to acyclovir or foscarnet was associated with clinical failure of these drugs; however, in vitro susceptibility to foscarnet was associated with complete response in only 5 of 7 patients. No strain from any of the 7 patients was resistant in vitro to cidofovir; however, only 3 of 7 patients achieved complete response. Therefore, acyclovir- and/or foscarnet-resistant HSV-1 infections after allogeneic stem cell transplantation have become a concern; current strategies need to be reassessed and new strategies must be evaluated in this setting.
在29个月内，196例异基因干细胞移植受者中诊断出14例严重的耐阿昔洛韦1型单纯疱疹病毒（HSV-1）感染，其中7例对膦甲酸钠耐药。无关干细胞移植受者的风险更高。所有患者均接受了膦甲酸钠治疗；8例随后接受了西多福韦治疗。3例患者的毒株最初对膦甲酸钠耐药，4例患者继发耐药。对阿昔洛韦或膦甲酸钠的体外耐药与这些药物的临床治疗失败相关；然而，体外对膦甲酸钠敏感仅与7例患者中的5例完全缓解相关。7例患者中任何一例的毒株在体外均未对西多福韦耐药；然而，7例患者中只有3例实现了完全缓解。因此，异基因干细胞移植后耐阿昔洛韦和/或膦甲酸钠的HSV-1感染已成为一个问题；当前策略需要重新评估，并且必须在此背景下评估新的策略。
