Acyclovir-resistant varicella zoster virus infection after chronic oral acyclovir therapy in patients with the acquired immunodeficiency syndrome (AIDS)

Article Abstract:

Infection with human immunodeficiency virus (HIV) is associated with an increased incidence of zoster, an inflammatory disease caused by varicella-zoster virus and characterized by skin lesions developing near skin nerves. Dermatomal or skin zoster is more severe and prolonged in patients with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC), which are associated with HIV. The antiviral agent acyclovir has been shown to be effective in treating patients with zoster in the presence or absence of HIV infection. Four cases are described of patients with HIV infection who received long-term oral therapy with acyclovir for recurrent varicella zoster or herpes simplex infection. These patients developed persistent, widespread hyperkeratotic lesions, characterized by overgrowth of the horny layer of the epidermis (the outer skin layer), despite high-dose acyclovir treatment. Varicella zoster virus resistant to acyclovir was isolated from the skin lesions of these patients. Greater than normal doses of the antiviral agents acyclovir, vidarabine, and foscarnet were required to prevent the continued growth of resistant virus in the four patients with zoster and HIV infection. These cases demonstrate that acyclovir-resistant varicella zoster virus infection is associated with the formation of hyperkeratotic skin lesions, and may complicate acyclovir therapy in patients with AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Acyclovir, Drug resistance, Shingles (Disease), Herpes zoster

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Foscarnet therapy in five patients with AIDS and acyclovir- resistant varicella-zoster virus infection

Article Abstract:

An evaluation was carried out of the effectiveness of foscarnet, a drug that inhibits viral replication, for treating infections caused by varicella-zoster virus (a member of the herpesvirus family) in five AIDS patients. While foscarnet appears effective against herpes simplex virus infections that are resistant to acyclovir (the drug commonly used for treating these infections), its value for treating acyclovir-resistance varicella-zoster infections has not been demonstrated. The patients' skin sores (lesions) had not healed after a 10-day course of acyclovir. Laboratory tests showed the presence of varicella-zoster virus. When foscarnet was administered for an average of 21 days, complete healing of the lesions in three patients, and virtually complete healing in one other patient was noted. The fifth patient did not heal, and tests indicated that the virus remained present. The patients had all undergone a previous, successful course of treatment with acyclovir for zoster infection. The effects of antiviral treatment on viral susceptibility to antiviral drugs is discussed. Because foscarnet administration can lead to toxicity, it should be used only for patients whose disease justifies this risk and for whom acyclovir resistance can be demonstrated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Varicella-zoster virus, Herpesvirus diseases, Herpesvirus infections, Foscarnet

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Cytomegalovirus esophagitis in patients with AIDS: A clinical, endoscopic, and pathologic correlation

Article Abstract:

Patients with AIDS often have gastrointestinal complications of the disease that are frequently localized in the esophagus. Symptoms often include dysphagia (difficulty with swallowing) or odynophagia (pain with swallowing). Candida esophagitis, a fungal infection, is the most common. Recently, esophageal infection by cytomegalovirus (CMV) has been recognized, but accurate diagnosis has been difficult. Sixteen AIDS patients with odynophagia underwent esophageal endoscopy with biopsy. In all 16, the biopsy specimens showed large intranuclear inclusions, which is characteristic of CMV infection. Only eight of the patients had biopsy specimens which grew CMV in culture. The current therapy for CMV esophagitis is the antiviral compound ganciclovir, but not all patients respond favorably. Those who fail to respond to ganciclovir had a poor prognosis in general. AIDS patients with dysphagia should be presumed to have Candida esophagitis and should be treated with antifungal agents. Those who fail to respond to antifungal therapy, or who have odynophagia, should undergo endoscopy with biopsy and microscopic examination of the tissue for typical viral inclusions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Physiological aspects, Cytomegalovirus infections, Esophagitis

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