Piperi Evangelia, Papadopoulou Erofili, Georgaki Maria, Dovrat Sara, Bar Illan Mor, Nikitakis Nikolaos G, Yarom Noam
Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens (NKUA), Athens, Greece.
Central Virology Laboratory, Public Health Services, Ministry of Health, Sheba Medical Center, Tel-Hashomer, Israel.
Oral Dis. 2024 Apr;30(3):877-894. doi: 10.1111/odi.14635. Epub 2023 Jun 6.
Herpes Simplex Virus (HSV) type 1 (HSV-1) and type 2 (HSV-2) are among the most common human viral pathogens, affecting several billion people worldwide. Although in healthy patients clinical signs and symptoms of HSV infection are usually mild and self-limiting, HSV-infections in immunocompromised patients are frequently more aggressive, persistent, and even life-threatening. Acyclovir and its derivatives are the gold standard antiviral drugs for the prevention and treatment of HSV infections. Although the development of acyclovir resistance is a rather uncommon condition, it may be associated with serious complications, especially in immunocompromised patients. In this review, we aim to address the problem of drug resistant HSV infection and discuss the available alternative therapeutic interventions. All relative studies concerning alternative treatment modalities of acyclovir resistant HSV infection published in PubMed between 1989 to 2022 were reviewed. Long-term treatment and prophylaxis with antiviral agents predisposes to drug resistance, especially in immunocompromised patients. Cidofovir and foscarnet could serve as alternative treatments in these cases. Although rare, acyclovir resistance may be associated with severe complications. Hopefully, in the future, novel antiviral drugs and vaccines will be available in order to avoid the existing drug resistance.
单纯疱疹病毒1型（HSV-1）和2型（HSV-2）是最常见的人类病毒病原体，全球有数十亿人受其影响。虽然在健康患者中，HSV感染的临床症状通常较轻且具有自限性，但免疫功能低下患者的HSV感染往往更具侵袭性、持续性，甚至危及生命。阿昔洛韦及其衍生物是预防和治疗HSV感染的金标准抗病毒药物。虽然阿昔洛韦耐药的情况并不常见，但可能会引发严重并发症，尤其是在免疫功能低下的患者中。在本综述中，我们旨在解决耐药HSV感染问题，并讨论现有的替代治疗干预措施。我们回顾了1989年至2022年间发表在PubMed上的所有关于阿昔洛韦耐药HSV感染替代治疗方式的相关研究。长期使用抗病毒药物进行治疗和预防易导致耐药，尤其是在免疫功能低下的患者中。在这些情况下，西多福韦和膦甲酸钠可作为替代治疗药物。虽然罕见，但阿昔洛韦耐药可能与严重并发症有关。希望未来能有新型抗病毒药物和疫苗，以避免现有的耐药问题。
