Safrin S, Elbaggari A, Elbeik T; International Conference on AIDS.

Int Conf AIDS. 1992 Jul 19-24; 8: Th75 (abstract no. ThB 1548).

San Francisco General Hospital, University of California 94110.

OBJECTIVES: We performed a case-control study to determine the risk factors associated with the development of acyclovir-resistant HSV infection in HIV-infected patients. METHODS: The Research Virology Laboratory at San Francisco General Hospital has served as a reference laboratory for testing of antiviral susceptibility to HSV since 1988. Resistance to acyclovir is defined as ID50 greater than or equal to 3 ug/ml by the plaque reduction assay; acyclovir-susceptible and -resistant control isolates are run with each test. Clinical information was requested from the referring physician regarding the following: location of lesion, length of time present, HSV type if known, response to antiherpes agents, first known outbreak of HSV, CD4 count, peripheral white blood cell count, and albumin level. Patients who were not HIV-infected were excluded. Univariate analyses were performed using the Wilcoxon rank-sum test; multivariate analyses used logistic regression. RESULTS: We studied 47 HIV-infected persons with in vitro resistance to acyclovir; "controls" were comprised of 23 HIV-infected persons in whom testing demonstrated susceptibility to acyclovir. Resistance to acyclovir in vitro was associated with the following variables by univariate analysis: absolute CD4 count (p = .02), duration of lesion at the time of referral for testing (p = .0001), lesion size (p = .05), absolute lymphocyte count (p = .03), days of acyclovir treatment for the acute episode (p = .01), and estimated weeks of lifetime acyclovir usage (p = .01). Multivariate analysis demonstrated that only absolute CD4 count (p = .02) and duration of the lesion (p = .03) were independently associated with in vitro resistance to acyclovir. Absolute CD4 count, absolute lymphocyte count, and serum albumin were highly intercorrelated (p approximately .002), and HSV type was highly associated with location of the lesion (p = .0001). CONCLUSIONS: Chronicity of mucocutaneous HSV infection and level of HIV-associated immunosuppression are the strongest risk factors for the development of resistance to acyclovir in vitro. Treatment of HIV-infected patients with CD4 less than 100/mm3 must include administration of adequate dosages of acyclovir until healing is complete.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Acyclovir
• Antiviral Agents
• Case-Control Studies
• Communicable Diseases
• HIV Infections
• HIV Seropositivity
• Humans
• In Vitro
• Plaque Assay
• Risk Factors
• San Francisco
• Simplexvirus

Other ID:

• 92400126

UI: 102197839

From Meeting Abstracts