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Herpes simplex virus reactivation among hematopoietic stem cell transplant recipients: re-evaluating acyclovir dosage

Bone Marrow Transplantation (2024)Cite this article

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Herpes complex virus (HSV) is a common viral infection post hematopoietic stem cell transplantation (HSCT), which affects up to 80% of seropositive recipients without prophylaxis [1,2,3]. International guidelines recommend antiviral prophylaxis for all HSV-seropositive allogeneic HSCT (allo-HSCT) recipients against HSV infection [4, 5]. Studies show that HSV reactivation rates post-HSCT range from 0 to 20% with prophylaxis, significantly lower than the 68–75% observed with placebo, highlighting acyclovir’s role as the preferred antiviral, despite varying dosage protocols [2, 3, 6].

The standard approach is to begin acyclovir prophylaxis at the start of the conditioning therapy and through engraftment or resolution of mucositis (approximately day +30) [4, 5]. The recommended prophylactic acyclovir dose ranges from 400 to 800 mg orally twice daily, but a wide spectrum of doses has been reported [2,3,4,5,6,7,8,9]. Acyclovir (ACV) 400 mg orally twice daily is the standard of care at our tertiary care hospital in the Ministry of National Guard Health Affairs (MNGHA) for HSV prevention. The rate of HSV reactivation after allo-HSCT is unknown in our population, and to date there have been no studies examining the incidence of HSV reactivation in Saudi Arabia. The study aimed to evaluate the incidence of HSV reactivation and identify risks of reactivation among patients who received ACV for HSV prevention post-HSCT.

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Fig. 1: Time from transplant to HSV reactivation.

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Authors and Affiliations

  1. Department of Pharmaceutical Care, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia

    Nada Alsuhebany, Bashayer Alshehri, Atheer Aldairem & Hajar AlQahtani

  2. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

    Nada Alsuhebany, Bashayer Alshehri, Atheer Aldairem, Hajar AlQahtani, Bader Alahmari & Mohsen Alzahrani

  3. College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Nada Alsuhebany, Atheer Aldairem, Khalid Albarqi, Basil Almotairi, Mohammed AlAmri, Walid Alanazi & Saeed Alay

  4. Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia

    Muneerah M. Aleissa

  5. King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Hajar AlQahtani, Bader Alahmari & Mohsen Alzahrani

  6. Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia

    Bader Alahmari & Mohsen Alzahrani

Authors
  1. Nada Alsuhebany
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  2. Bashayer Alshehri
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  12. Mohsen Alzahrani
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Contributions

NS, BS, HQ, ME, MZ and BA were responsible for designing the review protocol, and reviewing the final manuscript. AD, and ME were responsible for data analysis, and interpreting the results writing the manuscript. KB, BM, MA, WA, and SA were responsible for data collection and writing part of the manuscript.

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Correspondence to Muneerah M. Aleissa.

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Alsuhebany, N., Alshehri, B., Aldairem, A. et al. Herpes simplex virus reactivation among hematopoietic stem cell transplant recipients: re-evaluating acyclovir dosage. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02273-8

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