Bratzke B, Orfanos C E, Stavermann T, Ehlers G
Universitäts-Hautklinik und Poliklinik, Klinikum Steglitz, Freien Universität Berlin.
Hautarzt. 1991 Feb;42(2):96-100.
In an AIDS patient who had repeated successful treatment with acyclovir in his history, erosive herpes perianalis with herpes proctitis appeared, which persisted over several weeks. High-dose intravenous administration on of acyclovir (500-750 mg, 3 x daily, over 7 weeks) did not reveal any beneficial effects: However, almost complete clearing of the lesions occurred within 3 weeks of intravenous administration of Foscarnet (50 mg/kg body wt., 3 x daily). No relapse was seen in a follow-up period of 4 months. HSV type II was isolated by culture from the erosive lesions before treatment, but no virus was found 1 week after application of Foscarnet. The unusual chronic refractory course of a severe HSV type II infection in AIDS suggests the presence of an acyclovir-resistant HSV strain in this case. This is the first observation indicating acyclovir-resistance in the Federal Republic of Germany and a warning against the unlimited use of acyclovir in AIDS patients. Foscarnet may be beneficial in some of these cases.
一名有阿昔洛韦多次成功治疗史的艾滋病患者出现了肛周糜烂性疱疹合并疱疹性直肠炎，这种情况持续了数周。大剂量静脉注射阿昔洛韦（500 - 750毫克，每日3次，持续7周）未显示出任何有益效果：然而，在静脉注射膦甲酸钠（50毫克/千克体重，每日3次）3周内，皮损几乎完全消退。在4个月的随访期内未见复发。治疗前从糜烂性皮损中通过培养分离出II型单纯疱疹病毒，但在应用膦甲酸钠1周后未发现病毒。艾滋病患者中严重的II型单纯疱疹病毒感染出现异常慢性难治病程，提示该病例存在阿昔洛韦耐药的单纯疱疹病毒株。这是在德意志联邦共和国首次观察到阿昔洛韦耐药情况，警示不要在艾滋病患者中无限制使用阿昔洛韦。膦甲酸钠在某些此类病例中可能有益。
