Sall R K, Kauffman C L, Levy C S
Department of Infectious Diseases,Washington Hospital Center, Washington, DC 20010.
Arch Dermatol. 1989 Nov;125(11):1548-50.
We report a case of orofacial herpes simplex virus (HSV) infection that was progressive despite multiple courses of acyclovir sodium in a patient with the acquired immunodeficiency syndrome. The viral isolate was shown to be resistant to acyclovir in vitro, but proved susceptible to vidarabine and foscarnet sodium (trisodium phosphonoformate). The patient failed to respond to a 2-week course of intravenous vidarabine. However, rapid improvement in the orofacial lesion occurred with intravenous foscarnet. Most HSV isolates that are resistant to acyclovir are spontaneous mutants partially or completely lacking in thymidine kinase. Because foscarnet is a direct inhibitor of HSV DNA polymerase, this compound is expected to have efficacy against acyclovir-resistant strains. This report documents successful treatment of clinically significant HSV with intravenous administration of foscarnet, suggesting that further study is indicated.
我们报告了一例获得性免疫缺陷综合征患者的口面部单纯疱疹病毒（HSV）感染病例，尽管使用了多个疗程的阿昔洛韦钠治疗，但病情仍在进展。病毒分离株在体外显示对阿昔洛韦耐药，但对阿糖腺苷和膦甲酸钠（三钠膦甲酸）敏感。该患者对为期2周的静脉注射阿糖腺苷疗程无反应。然而，静脉注射膦甲酸钠后口面部病变迅速改善。大多数对阿昔洛韦耐药的HSV分离株是部分或完全缺乏胸苷激酶的自发突变体。由于膦甲酸钠是HSV DNA聚合酶的直接抑制剂，预计该化合物对阿昔洛韦耐药菌株有效。本报告记录了静脉注射膦甲酸钠成功治疗具有临床意义的HSV，表明有必要进一步研究。
