Benjamin Deane Kotton, Yale University, New Haven, Connecticut, USA.
Curr Opin Infect Dis. 2022 Dec 1;35(6):530-535. doi: 10.1097/QCO.0000000000000889. Epub 2022 Oct 7.
This review summarizes the literature on acyclovir resistant herpes infections and the most recent data pertinent to diagnosis and treatment in the immunocompromised patient population.
Although fairly rare, acyclovir resistant herpes infections can be challenging to diagnose. Clinicians should be aware of this entity when facing refractory herpes infections. With updated diagnostics, the diagnosis is usually made through viral culture and sequencing. Therapeutic choices depend on the extent of disease. Topical therapy may be appropriate for mucocutaneous disease. Intravenous antiviral therapies such as foscarnet and cidofovir may be necessary for disseminated, ophthalmologic, central nervous system, or visceral disease. Experimental therapies such as pritelivir are in clinical trials.
Immunosuppressed patients are at risk for developing acyclovir-resistant herpes, which can be challenging to diagnose and treat, although emerging therapeutic options look promising.
本文综述了阿昔洛韦耐药性疱疹感染的文献，以及免疫功能低下患者人群中与诊断和治疗最相关的最新数据。
尽管较为罕见，但阿昔洛韦耐药性疱疹感染的诊断具有一定挑战性。临床医生在面对难治性疱疹感染时应意识到这一情况。通过更新的诊断方法，通常通过病毒培养和测序来做出诊断。治疗选择取决于疾病的严重程度。对于黏膜皮肤疾病，局部治疗可能是合适的。对于播散性、眼、中枢神经系统或内脏疾病，可能需要静脉内抗病毒治疗，如膦甲酸和更昔洛韦。实验性治疗，如普瑞替韦，正在临床试验中。
免疫抑制患者有发生阿昔洛韦耐药性疱疹的风险，尽管新出现的治疗选择前景看好，但这种感染的诊断和治疗具有一定挑战性。
