Preemptive Treatment of Herpes Simplex Virus Reactivation in Critically Ill Patients?—Not Based on Current Data

In a multicenter randomized clinical trial by Luyt et al, twice-weekly screening for oropharyngeal reactivation of herpes simplex virus (HSV) followed by preemptive treatment with acyclovir during 14 days did not increase the number of ventilator-free days at day 60 in patients who received mechanical ventilation in the intensive care unit (ICU). The study informs a debate that has been ongoing for decades regarding the clinical relevance of HSV reactivation in patients without an apparent prior immunocompromised condition.