HSV excretion after bone marrow transplantation: a 4-year survey

Background: Herpes simplex virus (HSV) oral excretions are common after bone marrow transplantation (BMT). Objective: We report a 4-year systematic survey of HSV excretions in an adult population who underwent BMT (289 transplantations). Study design: Patients received either intravenous ACV treatment when mucositis occurred or systematic intravenous ACV prophylaxis from initiation of the BMT conditioning until the end of aplasia. All patients were followed up for HSV excretions. Results: Twenty-eight patients (9.7%) excreted HSV. The occurrence of HSV excretions was similar in both allogeneic and autologous transplant patients. The incidence was significantly lower when ACV was systematically used after transplantation (2.5%) compared to when ACV was implemented for mucositis (12%). ACV-resistant HSV was detected in three patients who received allogeneic tranplantation, representing 27% of allogeneic recipients excreting HSV. Conclusion: HSV infection prophylaxis with high dose of intravenous ACV resulted in a decreased incidence of HSV excretion. Nevertheless, the risk of emergence of ACV resistance, especially among allogeneic transplant patients, appears to be identical whatever the route and dose of ACV prophylaxis.