Management of Refractory/Resistant Herpes Simplex Virus Infections in Haematopoietic Stem Cell Transplantation Recipients: A Literature Review.

IF 9 2区 医学 Q1 VIROLOGY
Léo Sallée, David Boutolleau
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引用次数: 0

Abstract

Herpes simplex virus (HSV) infections in allogeneic haematopoietic stem cell transplantation (HSCT) recipients pose significant challenges, with higher incidence, severity, and risk of emergence of resistance to antivirals due to impaired T-cell mediated immunity. This literature review focuses on acyclovir-refractory/resistant HSV infections in HSCT recipients. The review addresses the efficacy of antiviral prophylaxis, the incidence of acyclovir-refractory/resistant HSV infections, and the identification of risk factors and potential prognostic impact associated with those infections. Additionally, alternative therapeutic options are discussed. While acyclovir prophylaxis demonstrates a significant benefit in reducing HSV infections in HSCT recipients and, in some cases, overall mortality, concerns arise about the emergence of drug-resistant HSV strains. Our systematic review reports a median incidence of acyclovir-resistant HSV infections of 16.1%, with an increasing trend in recent years. Despite limitations in available studies, potential risk factors of emergence of HSV resistance to acyclovir include human leucocyte antigen (HLA) mismatches, myeloid neoplasms and acute leukaemias, and graft-versus-host disease (GVHD). Limited evidences suggest a potentially poorer prognosis for allogeneic HSCT recipients with acyclovir-refractory/resistant HSV infection. Alternative therapeutic approaches, such as foscarnet, cidofovir, topical cidofovir, optimised acyclovir dosing, and helicase-primase inhibitors offer promising options but require further investigations. Overall, larger studies are needed to refine preventive and therapeutic strategies for acyclovir-refractory/resistant HSV infections in allogeneic HSCT recipients and to identify those at higher risk.

造血干细胞移植受者中难治性/耐药单纯疱疹病毒感染的处理:文献综述。
同种异体造血干细胞移植(HSCT)受者的单纯疱疹病毒(HSV)感染是一项重大挑战,其发病率较高、严重程度较重,而且由于 T 细胞介导的免疫功能受损,出现抗病毒药物耐药性的风险也较高。这篇文献综述的重点是造血干细胞移植受者的阿昔洛韦难治/耐药造血干细胞病毒感染。综述探讨了抗病毒预防措施的疗效、阿昔洛韦难治性/耐药 HSV 感染的发病率,以及与这些感染相关的风险因素和潜在预后影响。此外,还讨论了其他治疗方案。虽然阿昔洛韦预防治疗在降低造血干细胞移植受者的 HSV 感染率方面有显著疗效,在某些情况下还能降低总死亡率,但耐药 HSV 株的出现也令人担忧。我们的系统回顾报告显示,阿昔洛韦耐药 HSV 感染的中位发生率为 16.1%,近年来呈上升趋势。尽管现有研究存在局限性,但HSV对阿昔洛韦耐药的潜在风险因素包括人类白细胞抗原(HLA)不匹配、骨髓肿瘤和急性白血病以及移植物抗宿主病(GVHD)。有限的证据表明,患有阿昔洛韦难治性/耐药性 HSV 感染的异基因造血干细胞移植受者的预后可能较差。其他治疗方法,如福卡奈特、西多福韦、局部西多福韦、优化的阿昔洛韦剂量和螺旋酶-primase抑制剂等,都是很有前景的选择,但还需要进一步研究。总之,需要进行更大规模的研究,以完善异基因造血干细胞移植受者中阿昔洛韦难治性/耐药性 HSV 感染的预防和治疗策略,并确定高危人群。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Reviews in Medical Virology
Reviews in Medical Virology 医学-病毒学
CiteScore
21.40
自引率
0.90%
发文量
88
期刊介绍: Reviews in Medical Virology aims to provide articles reviewing conceptual or technological advances in diverse areas of virology. The journal covers topics such as molecular biology, cell biology, replication, pathogenesis, immunology, immunization, epidemiology, diagnosis, treatment of viruses of medical importance, and COVID-19 research. The journal has an Impact Factor of 6.989 for the year 2020. The readership of the journal includes clinicians, virologists, medical microbiologists, molecular biologists, infectious disease specialists, and immunologists. Reviews in Medical Virology is indexed and abstracted in databases such as CABI, Abstracts in Anthropology, ProQuest, Embase, MEDLINE/PubMed, ProQuest Central K-494, SCOPUS, and Web of Science et,al.
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