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Evidence for clinical activity of artesunate in multidrug-resistant herpes simplex infection following HSCT

Bone Marrow Transplantation volume 47, pages 1482–1483 (2012)Cite this article

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HSV-2 is a lifelong infection that causes recurrent genital ulcers and on rare occasions, disseminated and visceral disease, including hepatitis and pneumonitis. Host immune responses are critical determinants in the clearance of herpetic lesions.1 The corollary of this is that immunocompromised hosts, who lack such a response, may develop either high frequency of viral shedding or persistent, poorly healing genital lesions.

The nucleoside analogue aciclovir (ACV) is the antiviral drug of choice for the treatment and prophylaxis of HSV. In the setting of allogeneic HSCT it is often used to reduce symptomatic reactivation of both HSV and VZV,2, 3, 4 and symptomatic HSV infection is reduced from about 70% to 5–20%.5 However, ACV resistance due to mutations in viral DNA polymerase or more commonly thymidine kinase may develop.6 In immunocompromised patients, the prevalence of HSV infections with ACV resistance ranges from 3.5 to 25%, with the very highest rates reported in recipients of a HSCT.7 In ACV-resistant HSV, antiviral agents, such as Foscarnet (phosphono-formic acid (PFA)) and Cidofovir (CDV), are available but their use is limited by toxicity and drug resistance. There is a clear need for new antiviral agents.

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Acknowledgements

This work was undertaken at the University College London Hospitals/University College London, which received a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding Scheme. The funding sources had no involvement in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

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Authors and Affiliations

  1. Department of Haematology, University College London, London, UK

    R S Sellar, K J Thomson & K S Peggs

  2. Department of Haematology, University College London Hospitals Trust, London, UK

    R S Sellar & K S Peggs

  3. Department of Virology, University College London, London, UK

    K N Ward

  4. Department of Virology, University College London Hospitals Trust, London, UK

    K N Ward

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  1. R S Sellar
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Correspondence to K S Peggs.

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Sellar, R., Ward, K., Thomson, K. et al. Evidence for clinical activity of artesunate in multidrug-resistant herpes simplex infection following HSCT. Bone Marrow Transplant 47, 1482–1483 (2012). https://doi.org/10.1038/bmt.2012.46

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