Acyclovir-resistant herpes simplex virus infection is common in immunocompromised patients, but the course of such infection is little known. We describe the long-term follow-up of HIV-infected patients diagnosed once with acyclovir-resistant herpes simplex virus infections.

We retrospectively studied all HIV-infected patients between 2000 and 2010 diagnosed with virologically confirmed acyclovir-resistant herpes simplex virus infection. Patient’s socio-demographic and immunovirological characteristics were described. Response to foscarnet or cidofovir and recurrences were reported.

Among 5295 HIV-infected patients, 13 (0.2%) were once diagnosed with an acyclovir-resistant herpes simplex virus infection. Twelve patients were men, nine patients were of African origin. All patients reported previous acyclovir exposure and median CD4 cell count was 183/mm³. Ten patients presented exclusively with cutaneous lesions. Initially, 11 patients were treated with foscarnet and two with cidofovir. The median follow-up was 67 months (6–145). All patients recurred, 10 presenting at least one acyclovir-resistant herpes simplex virus recurrence. The median number of acyclovir-resistant herpes simplex virus recurrences per patient was 2 (0 – 5). Regarding the first and second recurrences, 7/13 (54%) and 5/11 (45%) herpes simplex virus clinical isolates exhibited resistance to –acyclovir, respectively.

Acyclovir-resistant herpes simplex virus infections prevalence was low in our cohort. The rate of acyclovir-resistant herpes simplex virus episodes averaged 50% during the two first recurrences.