Recurrence and Resistance Patterns of Herpes Simplex Virus following Cessation of >=6 Years of Chronic Suppression with Acyclovir

Authors:
  • CCClyde S. Crumpacker
    Clyde S. Crumpacker
  • GMGregory J. Mertz
    Gregory J. Mertz
  • EHEdgar L. Hill
    Edgar L. Hill
  • GBGloria S. Boone
    Gloria S. Boone
  • AGAcyclovir Study Group
    Acyclovir Study Group
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Abstract
Questions have arisen regarding the clinical outcome and the possible selection of resistant virus when patients with genital herpes discontinue prolonged chronic acyclovir; 239 immunocompetent patients with a history of frequently recurring genital herpes who stopped successful suppressive therapy after 6 years were studied. Of the patients, 85.8% had at least one recurrence and 75% had at least two recurrences in the subsequent year (median time to first and second recurrence, 68 and 180 days, respectively). Herpes simplex virus isolates recovered from these patients had a median acyclovir sensitivity of 0.79 µg/mL and 4 (3.5%) were resistant (⩾3 µg/mL). These values are comparable to those of pretherapy isolates and to reported values of isolates from acyclovir-naive patients. Also, paired pre- and posttherapy isolates from 13 patients showed no trend toward development of resistance. Thus, even after 6 years of acyclovir suppression, most patients continue to have recurrences, but the selection of resistant virus has not been observed.