AIDS TREATMENT NEWS No. 115 - November 27, 1990
Michelle Roland
The only published report on trifluridine treatment of acyclovir-resistant herpes in a person with HIV infection was presented at the Sixth International Conference on AIDS in San Francisco in June, 1990 [Doherty and others, abstract Th.B. 446]. This patient first had acyclovir-resistant herpes lesions which responded to foscarnet. However, a subsequent lesion was resistant to both acyclovir and foscarnet. Two other topical treatments (idoxuridine cream; interferon gel alone) were tried but failed in this patient before she responded to the combination of trifluridine and interferon with "considerable but incomplete healing."
Two other cases were discussed by Harold Kessler, M. D., from Rush-Presbyterian St. Luke's Medical Center in Chicago, at the recent meeting of the AIDS Clinical Trials Group (ACTG) in Washington, D. C. (The ACTG is a research program of the National Institute of Allergy and Infectious Diseases of the National Institutes of Health; it is the group which conducts the bulk of the Federally sponsored AIDS clinical research in this country.) Dr. Kessler emphasized that there is no proof that trifluridine is effective in acyclovir-resistant herpes, because there have been no studies of this treatment. In addition, he knows of a total of only four episodes of herpes in three patients who were treated with this drug. However, he agreed that this information should be made available to patients and physicians before the completion of a controlled study since there are few alternative treatments currently available to people with herpes lesions that are resistant to both acyclovir and foscarnet.
Dr. Kessler described applying a thin film of the solution over a well-cleansed lesion. He then covered the lesion with a thin layer of Polysporin ointment to keep the solution in contact with the lesion. Gauze was placed over the lesion. The medication and dressing were changed three times a day. One patient (with a lesion of three by four centimeters) responded in four to five weeks. This patient relapsed with a lesion that was next to the original one. The second lesion healed within two weeks with treatment with trifluridine. A second patient was treated at another medical center and had a complete response in two weeks.
Dr. Kessler emphasized that this treatment is not a cure for herpes simplex infections. New lesions will occur after treatment with any anti-herpes drug. However, new lesions may be susceptible to acyclovir and/or foscarnet.
An open-label prospective study of this drug is being designed for people with chronic cutaneous herpes which is suspected of being acyclovir resistant. In the meantime, Dr. Kessler has requested that physicians trying trifluridine send viral isolates for acyclovir and foscarnet resistance testing to his laboratory in Chicago so that the effectiveness of trifluridine can be assessed before the official study is under way. Physicians can reach Dr. Kessler at 312/942-5865 (Division of Infectious Diseases, Rush-Presbyterian St. Luke's Medical Center, Chicago).
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