A note from The Body.com: The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information! Unfortunately, cases of herpes that are resistant to these drugs are increasingly leaving doctors and their patients with few options. However, a group of doctors in New York recently reported the case of a person with AIDS who successfully recovered from drug-resistant herpes when he was treated with the immune booster Aldara (imiquimod). The doctors provided details on a 34-year-old man whose CD4 count was 200 cells and whose viral load was "undetectable." He had been taking highly active antiretroviral therapy (HAART) for about a year and had symptoms of herpes on his genitals for about five months. Doctors prescribed the following regimens one at a time to treat the herpes infection: Because these drugs did not help, doctors then prescribed 5% Aldara cream, which the man applied to his lesions and then washed off eight hours later. “The incidence of herpes simplex viruses resistant to acyclovir is going up and up,” said Toby Maurer, MD, professor of clinical dermatology at the University of California, San Francisco, at a recent HIV grand rounds presentation at San Francisco General Hospital. Acyclovir is an antiviral medication commonly used to reduce pain and hasten healing of herpes simplex (HSV) sores. But when HSV develops a resistance to acyclovir, infected people can develop skin lesions—hypertrophic masses near or on the genitals that can be painful and unsightly. These occur more frequently in people who are living with HIV or have compromised immune systems, may be difficult to treat and can recur even after treatment. Maurer cited a retrospective study of immunocompromised people that showed an incidence increase in acyclovir-resistant herpes simplex from 3% to 14% over ten years. She said that acyclovir-resistant herpes simplex can develop even in people with healthy CD4 counts. She also pointed to examples from recent cases she’s seen as a dermatologist in the U. “We saw resistance in the [past] when CD4 counts were under 50. They’re not particularly immunosuppressed.” It’s possible, said Maurer, that long courses of acyclovir taken to prevent herpes simplex outbreaks can lead to development of drug-resistant forms of the virus—although there’s no definitive evidence yet. In one long-term follow-up study that included 13 people who were diagnosed with acyclovir-resistant HSV infection, all had been previously treated with long courses of acyclovir before their first hypertrophic herpes simplex breakout.
Safety data for valacyclovir and acyclovir in a range of patient groups are presented, focusing primarily on use for HSV indications. The findings of recent resistance monitoring initiatives indicate that HSV should remain sensitive to valacyclovir therapy, despite a long history of acyclovir usage. Experience with Acyclovir There was no evidence of development of resistant HSV in the 4 trials of valacyclovir for genital herpes suppression table 3;.