Intravenous Foscarnet With Topical Cidofovir for Chronic Refractory Genital Herpes in a Patient With AIDS.

Agnes Usoro,Alfreda Batts,Juan C Sarria

doi:10.1177/2324709615621095

Abstract

Few case reports have documented the use of topical cidofovir for refractory genital herpes simplex virus (HSV) ulcers in human immunodeficiency virus (HIV) infected patients. This drug formulation lacks a standardized concentration or even a procedural outline as to how it should be compounded. We aim to discuss the utilization of topical cidofovir in addition to presenting a procedural means of compounding it for treatment of refractory genital HSV ulcers. Our patient completed 21 days of intravenous foscarnet and 13 days of topical cidofovir with clinical improvement in the penile and scrotal ulcers. Genital herpes is a concern in patients with HIV because it generally manifests as a persistent infection. Physicians should be aware that when patients fail to respond to the conventional treatment regimens for genital HSV in a timely manner, other options are available, such as topical cidofovir as an adjuvant to systemic antivirals.

Highlights

In the United States, 1 in 6 people ages 14 to 49 have genital herpes.[1]
Genital herpes is generally caused by herpes simplex virus (HSV) type 2, rates of HSV type 1 infections are increasing, with the prevalence of genital herpes in patients with human immunodeficiency virus (HIV) infection approaching 50% to 90%
Immunocompromised persons who are infected with genital HSV tend to exhibit persistent and extensive ulcers, which commonly fail to respond to conventional antiviral regimens

Summary

Introduction

In the United States, 1 in 6 people ages 14 to 49 have genital herpes.[1]. Genital herpes is generally caused by herpes simplex virus (HSV) type 2, rates of HSV type 1 infections are increasing, with the prevalence of genital herpes in patients with human immunodeficiency virus (HIV) infection approaching 50% to 90%.2 In immunocompetent individuals, mucocutaneous infections are generally self-limited. Diagnostic considerations included genital HSV, granuloma inguinale, and atypical syphilis Intravenous foscarnet, another nucleoside analogue, 75 mg/kg twice daily, and oral doxycycline 100 mg twice daily were initiated. Literature review revealed several reports that outlined successful use of topical cidofovir and topical imiquimod for treatment of HSV cutaneous infections.[3,4,5,6] Cidofovir is a nucleotide analogue that does not require enzyme activation for activity, unlike acyclovir and foscarnet. The rationale for utilizing oral acyclovir despite suspicions of an acyclovir-resistant infection came from studies revealing that isolated strains of HSV from a cutaneous ulcer exhibited reversion from acyclovir-resistant to acyclovir-susceptible following therapy with cidofovir.[5,7] In addition, due to formulary constraints within the department of corrections, topical cidofovir was transitioned to topical imiquimod 5% thrice weekly for 1 month.

Discussion

Declaration of Conflicting Interests