Abstract：
Herpes simplex virus (HSV) infections in allogeneic haematopoietic stem cell transplantation (HSCT) recipients pose significant challenges, with higher incidence, severity, and risk of emergence of resistance to antivirals due to impaired T-cell mediated immunity. This literature review focuses on acyclovir-refractory/resistant HSV infections in HSCT recipients. The review addresses the efficacy of antiviral prophylaxis, the incidence of acyclovir-refractory/resistant HSV infections, and the identification of risk factors and potential prognostic impact associated with those infections. Additionally, alternative therapeutic options are discussed. While acyclovir prophylaxis demonstrates a significant benefit in reducing HSV infections in HSCT recipients and, in some cases, overall mortality, concerns arise about the emergence of drug-resistant HSV strains. Our systematic review reports a median incidence of acyclovir-resistant HSV infections of 16.1%, with an increasing trend in recent years. Despite limitations in available studies, potential risk factors of emergence of HSV resistance to acyclovir include human leucocyte antigen (HLA) mismatches, myeloid neoplasms and acute leukaemias, and graft-versus-host disease (GVHD). Limited evidences suggest a potentially poorer prognosis for allogeneic HSCT recipients with acyclovir-refractory/resistant HSV infection. Alternative therapeutic approaches, such as foscarnet, cidofovir, topical cidofovir, optimised acyclovir dosing, and helicase-primase inhibitors offer promising options but require further investigations. Overall, larger studies are needed to refine preventive and therapeutic strategies for acyclovir-refractory/resistant HSV infections in allogeneic HSCT recipients and to identify those at higher risk.
摘要：
同种异体造血干细胞移植（HSCT）受者中的单纯疱疹病毒（HSV）感染构成了重大挑战，发病率较高，严重程度,以及由于T细胞介导的免疫力受损而出现对抗病毒药物抗性的风险。本文献综述集中于HSCT受者中阿昔洛韦难治性/耐药性HSV感染。这篇综述讨论了抗病毒预防的疗效，阿昔洛韦难治性/耐药性HSV感染的发生率，以及与这些感染相关的危险因素和潜在的预后影响的识别。此外,讨论了替代治疗方案。虽然阿昔洛韦预防在减少HSCT受者的HSV感染方面具有显着的益处，在某些情况下,总死亡率，人们对耐药HSV菌株的出现感到担忧。我们的系统评价报告，阿昔洛韦耐药HSV感染的中位发病率为16.1%，近年来呈上升趋势。尽管现有研究的局限性，出现HSV对阿昔洛韦耐药的潜在危险因素包括人类白细胞抗原（HLA）错配，骨髓性肿瘤和急性白血病，和移植物抗宿主病（GVHD）。有限的证据表明，患有阿昔洛韦难治性/耐药性HSV感染的同种异体HSCT受者的预后可能较差。替代治疗方法，比如Foscannet,西多福韦,局部西多福韦，优化阿昔洛韦剂量，和解旋酶-启动酶抑制剂提供了有希望的选择，但需要进一步的研究。总的来说,需要更大规模的研究来完善同种异体HSCT受者中阿昔洛韦难治性/耐药性HSV感染的预防和治疗策略,并确定高危人群.
