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- Title
Acyclovir Prophylaxis Predisposes to Antiviral-Resistant Recurrent Herpetic Keratitis.
- Authors
van Velzen, Monique; van de Vijver, David A. M. C.; van Loenen, Freek B.; Osterhaus, Albert D. M. E.; Remeijer, Lies; Verjans, Georges M. G. M.
- Abstract
Purpose. Long-term acyclovir (ACV) prophylaxis, recommended to prevent recurrent herpes simplex virus type 1 (HSV-1) ocular disorders, may pose a risk for ACV-refractory disease due to ACV resistance. We determined the effect of ACV prophylaxis on the prevalence of corneal ACV-resistant (ACVR) HSV-1 and clinical consequences thereof in patients with recurrent HSV-1 keratitis (rHK).Methods. Frequencies of ACVR viruses were determined in 169 corneal HSV-1 isolates from 78 rHK patients with a history of stromal disease. The isolates' ACV susceptibility profiles were correlated with clinical parameters to identify risk factors predisposing to ACVR rHK.Results. Corneal HSV-1 isolates with >28% ACVR viruses were defined as ACVR isolates. Forty-four isolates (26%) were ACV-resistant. Multivariate analyses identified long-term ACV prophylaxis (≥12 months) (odds ratio [OR] 3.42; 95% confidence interval [CI], 1.32–8.87) and recurrence duration of ≥45 days (OR 2.23; 95% CI, 1.02–4.87), indicative of ACV-refractory disease, as independent risk factors for ACVR isolates. Moreover, a corneal ACVR isolate was a risk factor for ACV-refractory disease (OR 2.28; 95% CI, 1.06–4.89).Conclusions. The data suggest that long-term ACV prophylaxis predisposes to ACV-refractory disease due to the emergence of corneal ACVR HSV-1. ACV-susceptibility testing is warranted during follow-up of rHK patients.
- Subjects
ACYCLOVIR; ANTIVIRAL agents; KERATITIS; DISEASE relapse; HERPES simplex virus; DRUG resistance in microorganisms; DISEASE prevalence
- Publication
Journal of Infectious Diseases, 2013, Vol 208, Issue 9, p1359
- ISSN
0022-1899
- Publication type
Article
- DOI
10.1093/infdis/jit350