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. 2024 Feb 5;11(3):ofae046.
doi: 10.1093/ofid/ofae046. eCollection 2024 Mar.

A Multicenter Assessment of the Outcomes and Toxicities of Foscarnet for Treatment of Acyclovir-Resistant Mucocutaneous Herpes Simplex in Immunocompromised Patients

Sarah P Hammond  1 , Manickam Rangaraju  2 , Melanie Sumner  2 , Burkhard Timmler  2 , Pranatharthi Chandrasekar  3 , Robin K Avery  4
Affiliations

A Multicenter Assessment of the Outcomes and Toxicities of Foscarnet for Treatment of Acyclovir-Resistant Mucocutaneous Herpes Simplex in Immunocompromised Patients

Sarah P Hammond et al. Open Forum Infect Dis. .

Abstract

Background: Acyclovir-resistant mucocutaneous herpes simplex virus (HSV) infection is an uncommon problem typically seen in immunocompromised hosts. Systemic treatment options are limited. The performance of foscarnet and its toxicities in this population are poorly characterized.

Methods: This was a multicenter retrospective study of adults treated with foscarnet for HSV infection between January 2012 and December 2017. Relevant data were collected including demographics, baseline conditions, previous anti-HSV medications, concomitant medications, HSV outcomes, and adverse events. Acyclovir-resistant HSV infection was defined based on genotypic or phenotypic testing results; refractory infection was defined as infection not improving after 5 days of treatment-dosed antiviral therapy in those not tested for resistance.

Results: Twenty-nine patients had 31 episodes of HSV (15/18 resistant; among episodes without resistance testing, 7/10 refractory; 3 not evaluable) treated with foscarnet. All patients were immunocompromised including 19 (66%) with hematologic malignancy and 9 (31%) with HIV. Median duration of foscarnet was 16 days (range, 6-85 days). Fifteen episodes (48%) healed by the end of or after foscarnet. Median time to healing among those with resolution was 38 days (range, 9-1088 days). At least 1 adverse event during therapy was reported in 26 (84%) treatment episodes including 23 (74%) that were considered drug related. Common adverse events were electrolyte disturbance (20 [65%]) and kidney dysfunction (13 [42%]). Foscarnet was discontinued in 10 episodes (32%) due to an adverse event, including 6 due to kidney dysfunction.

Conclusions: Among 31 episodes of HSV treated with foscarnet, only half resolved with treatment, and adverse events were common.

Keywords: acyclovir; foscarnet; herpes simplex virus.

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Conflict of interest statement

Potential conflicts of interest. S. P. H. has received research funding from Cidara, F2G, GSK, and Scynexis and has served as on advisory boards or as a consultant for F2G, Melinta, Pfizer, Roche, and Seres Therapeutics. M. R., M. S., and B. T. are current or past employees of AiCuris. R. K. A. has received research support from AiCuris, Astellas, AstraZeneca, Chimerix, Merck, Oxford Immunotec, Qiagen, Regeneron, and Takeda. P. C. reports no conflicts of interest.

Figures

Graphical abstract
Graphical abstract
This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/a-multi-center-assessment-of-the-outcomes-and-toxicities-of-foscarnet-for-treatment-of-acyclovir-resistant-mucocutaneous-herpes-simplex-in-immunocompromised-patients
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