TY - JOUR
T1 - Treatment of Resistant Herpes Simplex Virus With Continuous-Infusion Acyclovir
AU - Engel, Jeffrey P.
AU - Englund, Janet A.
AU - Fletcher, Courtney V.
AU - Hill, Edgar L.
PY - 1990/3/23
Y1 - 1990/3/23
N2 - Two patients with acquired immunodeficiency syndrome who developed severe ulcerative proctitis caused by herpes simplex virus type 2 that was resistant to acyclovir were successfully treated with 6 weeks of high-dose, continuousinfusion acyclovir sodium (1.5 to 2.0 mg/kg per hour). Viruses cultured from the lesions were resistant to acyclovir in vitro after the patients had received prolonged therapy with oral and intravenous acyclovir in traditional divided doses. Investigation into the mechanism of the acyclovir resistance revealed changes in the thymidine-kinase activity of both isolates. This viral enzyme phosphorylates acyclovir and is necessary for drug activation. The first patient’s isolate was deficient of all thymidine-kinase activity, while the second patient’s isolate had a thymidine kinase with altered substrate specificity for acyclovir. The continuous infusion was safe, well tolerated, and done in an outpatient setting with weekly clinic visits and monitoring of creatinine and acyclovir levels.
AB - Two patients with acquired immunodeficiency syndrome who developed severe ulcerative proctitis caused by herpes simplex virus type 2 that was resistant to acyclovir were successfully treated with 6 weeks of high-dose, continuousinfusion acyclovir sodium (1.5 to 2.0 mg/kg per hour). Viruses cultured from the lesions were resistant to acyclovir in vitro after the patients had received prolonged therapy with oral and intravenous acyclovir in traditional divided doses. Investigation into the mechanism of the acyclovir resistance revealed changes in the thymidine-kinase activity of both isolates. This viral enzyme phosphorylates acyclovir and is necessary for drug activation. The first patient’s isolate was deficient of all thymidine-kinase activity, while the second patient’s isolate had a thymidine kinase with altered substrate specificity for acyclovir. The continuous infusion was safe, well tolerated, and done in an outpatient setting with weekly clinic visits and monitoring of creatinine and acyclovir levels.
UR - http://www.scopus.com/inward/record.url?scp=0025268266&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0025268266&partnerID=8YFLogxK
U2 - 10.1001/jama.1990.03440120084042
DO - 10.1001/jama.1990.03440120084042
M3 - Article
C2 - 2308204
AN - SCOPUS:0025268266
VL - 263
SP - 1662
EP - 1664
JO - JAMA - Journal of the American Medical Association
JF - JAMA - Journal of the American Medical Association
SN - 0002-9955
IS - 12
ER -