Recurrent Infection with Herpes Simplex Virus after Marrow Transplantation: Role of the Specific Immune Response and Acyclovir Treatment

Herpes simplex virus (HSV) reactivation is common after marrow transplantation, with some patients developing frequent and severe recurrences. Sixty patients were studied to determine both the effect of the specific lymphocyte response to HSV on subsequent recurrences and the effect of acyclovir treatment on restoration of this response. Patients with a positive response after the first HSV recurrence had fewer second recurrences (13 of 28 vs. 18 of 19; P less than .01) and at a longer interval when they did recur (42 vs. 27 days; P less than .0001). Conversely, patients treated with acyclovir had more frequent second recurrences than did those not treated (18 of 21 vs. 13 of 26; P less than .05) and they were at a shorter interval when they did recur (27 vs. 36 days; P = .001). Treated patients also had lower specific lymphocyte responses to HSV. These data confirm the importance of the specific immune response to HSV in the determination of the course of HSV infection after marrow transplant.