Journal Article

Clinical and Virologic Characterization of Acyclovir-Resistant Varicella-Zoster Viruses Isolated from 11 Patients with Acquired Immunodeficiency Syndrome

Estelle Saint Léger, Eric Caumes, Guillaume Breton, Danielle Douard, Philippe Saiag, Jean-Marie Huraux, François Bricaire, Henri Agut and Anne-Marie Fillet

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 33, issue 12, pages 2061-2067
Published in print December 2001 | ISSN: 1058-4838
Published online December 2001 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/324503
Clinical and Virologic Characterization of Acyclovir-Resistant Varicella-Zoster Viruses Isolated from 11 Patients with Acquired Immunodeficiency Syndrome

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We studied the clinical resistance to acyclovir of infections with varicella-zoster viruses (VZV) in patients with acquired immunodeficiency syndrome, and we correlated it to virologic analyses. Eleven patients with VZV infections (treated with acyclovir, 30 mg/kg/day, given intravenously, or 4 g/day, given orally) were included in the study because of the failure of 10 days of acyclovir therapy. Susceptibility of VZV isolates to acyclovir was tested using a plaque reduction assay to determine the 50% inhibitory concentration (IC50) of acyclovir and the SI50 (IC50 of the patient isolate/IC50 of the reference strain) to acyclovir. The thymidine kinase (TK) gene, which supports the resistance, was sequenced on amplified products. Only 3 patients had a significant increase in the IC50, as compared with the IC50 of the reference strain (SI50 of ⩾4), and a mutation in the TK gene. For the other 8 patients, the clinical resistance was not confirmed by the virologic results: the SI50 was <4, and no mutation was detected in the TK gene. Because no acyclovir-resistant strain appeared during a shorter period of time, we suggest an increase in the duration of the treatment to 21 days before acyclovir resistance is suspected.

Journal Article.  3053 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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