Management of acyclovir-resistant herpes simplex virus

Acyclovir and related compounds are the mainstay of therapy of infections that are caused by human herpesvirus types 1, 11, and III. Resistance to this class of drugs has increased among patients who are immunocompromised (bone marrow and organ transplant patients, patients with cancer, and patients infected with HIV), leading to persistent mucocutaneous lesions or serious systemic infections. Alternative treatment regimens include parenteral foscarnet, vidarabine, and cidofovir, as well as topical foscarnet, cidofovir, trifluridine, and imiquimod. Ribonucleotide reductase inhibitors offer considerable promise for future treatment.