Product information and disease description Place of product in therapy Disease description Epidemiology

Incidence of Refractory mucocutaneous herpes simplex virus infection in immunocompromised adults

12 evidence topics · 13 sources

Hematopoietic cell transplant recipients: two-year probability of acyclovir-resistant disease by duration of prophylaxis, United States

“The effect that long-term use of suppressive acyclovir (ACV) has on both overall herpes simplex virus (HSV) disease and ACV-resistant HSV disease was examined in 3 consecutive cohorts of hematopoietic stem-cell transplant (HCT) recipients (n=2049); cohort 1 received ACV for 30 days after HCT, cohort 2 received it for 1 year after HCT, and cohort 3 received it for an extended period (i.e., >1 year) if the patient's immunosuppression continued after 1 year.” (opens the source at this quote in a new tab)
“ACV-resistant HSV disease developed in 10 patients in cohort 1 (2-year probability, 1.3% [95% CI, 0.8%-2.7%]), in 2 patients in cohort 2 (2-year probability, 0.2% [95% CI, 0%-0.8%]; P=.006), and in 0 patients in cohort 3 (cohort 2 vs. cohort 3, P=.3).” (opens the source at this quote in a new tab)

Allogeneic transplant recipients at one United States cancer center: incidence of laboratory-confirmed acyclovir-resistant infection

“A total of 4028 allogeneic HCTs were performed at our center between 2002 through 2014, and among the recipients, the incidence of laboratory-confirmed acyclovir-resistant infections was 0.4% (18 patients).” (opens the source at this quote in a new tab)
“A total of 4028 HCTs were performed during the study period, and 18 of the recipients met the diagnostic criteria for acyclovir-resistant HSV. All cases had undergone allogeneic HCTs.” (opens the source at this quote in a new tab)

Adult allogeneic transplant recipients on prophylaxis: breakthrough and refractory or resistant infection within 100 days, United States preprint

“Patients who received their first aHCT at Fred Hutchinson Cancer Center between 2002-2022 were reviewed for breakthrough HSV infection within the first 100 days on prophylaxis (acyclovir 800 mg or valacyclovir 500 mg twice daily).” (opens the source at this quote in a new tab)
“Refractory/resistant (R/R) infections were defined according to consensus guidelines.” (opens the source at this quote in a new tab)
“We reviewed data from 4,357 aHCT recipients aged ≥18 years, among whom 3,749 (86%) were HSV seropositive and 23 developed breakthrough HSV infection (observed probability = 0.6%). Among those who had an infection, the median time from transplant to first positive test was 46 days (IQR: 24.0-69.5).” (opens the source at this quote in a new tab)
“In total, 11 of 23 (47.8%) patients with breakthrough HSV developed R/R infection.” (opens the source at this quote in a new tab)

Hematopoietic stem cell transplant recipients: median incidence of acyclovir-resistant infection across studies in a systematic review

“Our systematic review reports a median incidence of acyclovir-resistant HSV infections of 16.1%, with an increasing trend in recent years.” (opens the source at this quote in a new tab)

Hematopoietic stem cell transplant recipients: emergence of acyclovir-resistant HSV-1 shedding within 100 days, prospective study in Japan

“Oropharyngeal swab samples were serially collected each week from 1 week before and up to 100 days after HSCT and were tested for virus isolation.” (opens the source at this quote in a new tab)
“Herpes simplex virus type 1 was isolated in 39 of 268 (15%) HSCT patients within 100 days after transplantation. Acyclovir-resistant HSV-1 emerged in 11 of these 39 patients (28%).” (opens the source at this quote in a new tab)

Allogeneic stem cell transplant recipients: severe acyclovir-resistant HSV-1 infections over 29 months, France

“Fourteen cases of severe acyclovir-resistant herpes simplex virus type 1 (HSV-1) infection, 7 of which showed resistance to foscarnet, were diagnosed among 196 allogeneic stem cell transplant recipients within a 29-month period.” (opens the source at this quote in a new tab)
“Strains were initially foscarnet-resistant in 3 patients and secondarily so in 4 patients.” (opens the source at this quote in a new tab)

Allogeneic hematopoietic cell transplant recipients: severe acyclovir-resistant HSV-1 stomatitis among consecutive recipients, Germany

“Among 214 consecutive HCT patients, 6 developed severe ACVr HSV-1 stomatitis (WHO grade III n = 1, WHO grade IV n = 5).” (opens the source at this quote in a new tab)

Allogeneic stem cell transplant recipients: clinical and laboratory resistance among 75 recipients, United Kingdom

“Herpes simplex virus (HSV) infections in 75 allogeneic stem cell transplant recipients were analyzed. Sixteen patients developed HSV disease following transplantation.” (opens the source at this quote in a new tab)
“Seven patients did not respond to acyclovir, and 3 patients failed to respond to foscarnet. Isolates from 4 patients developed resistance to acyclovir/penciclovir, and 3 patients had foscarnet-resistant isolates. The remaining 3 patients failed to respond to acyclovir, despite having sensitive isolates.” (opens the source at this quote in a new tab)

Haploidentical transplant recipients with lymphocyte-depleted grafts: reactivation and resistance among 14 adults, United States

“Fourteen adults with hematologic malignancies underwent blood HPC transplantation from haploidentical family donors.” (opens the source at this quote in a new tab)
“HSV reactivation occurred in all 7 evaluable HSV-1- or HSV-2-seropositive patients, at a median of 40 days after transplantation. Susceptibility testing of clinically resistant viral isolates demonstrated acyclovir resistance in all 5 cases tested. Second-line therapy produced only partial responses, and in vitro evidence of foscarnet resistance developed rapidly in all 3 patients treated with foscarnet.” (opens the source at this quote in a new tab)

Solid organ transplant recipients: time from transplantation to resistant infection in a French case series

“In SOT recipients, resistant HSV infection occurred at a mean of 172 days post-transplantation.” (opens the source at this quote in a new tab)

Ranges of incidence in hematopoietic cell transplant recipients stated in reviews and study introductions

“the reported incidence of acyclovir-resistant HSV infections in HCT recipients ranges from 7% to as high as 36%” (opens the source at this quote in a new tab)

“This is reflected by the high incidence of HSV resistance to ACV in immunocompromised patients, including HCT recipients that ranges between 10% and 30%” (opens the source at this quote in a new tab)

Incidence of any HSV reactivation or disease after hematopoietic cell transplantation

“The 2-year probability of HSV disease was 31.6% (95% confidence interval [CI], 28.0%-35%) in cohort 1, 3.9% (95% CI, 2.7%-5.2%) in cohort 2, and 0% in cohort 3 (P<.001).” (opens the source at this quote in a new tab)

“In an earlier era, over 70% of HCT recipients experienced HSV reactivation, and the use of acyclovir prophylaxis has brought that rate down to 12%” (opens the source at this quote in a new tab)

“systematic antiviral prophylaxis in these patients has resulted in a dramatic reduction in the incidence of HSV infections, decreasing from 80% to 10% in hematopoietic cell transplantation (HCT) patients” (opens the source at this quote in a new tab)

“Patients receiving either autologous or allogeneic bone marrow transplants had a similar incidence, i.e., 9%, of HSV infection, but resistance occurred only in allogeneic transplants, reaching a prevalence of 30%” (opens the source at this quote in a new tab)