Herpes Simplex Virus Infections In Solid Organ Transplantation
Publication Date: March 12, 2019
Recommendations
DIAGNOSTIC STRATEGIES
Most HSV infections are diagnosed on clinical grounds. (, )
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Polymerase chain reaction is the preferred test for sampling lesions and CSF. (High, Strong)
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Polymerase chain reaction testing of other samples may be used as an adjunct to clinical, pathological, and other laboratory testing. (Low, Weak)
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Culture and DFA may be helpful where PCR testing is not available. Culture may be helpful when nucleoside resistance is suspected. (, )
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Early diagnosis is associated with improved outcomes. (Low, Strong)
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TREATMENT
For limited mucocutaneous lesions, oral therapy can be used and therapy should be continued for a minimum of 5‐7 days or until complete healing of the lesions depending on the clinical circumstances. (High, Strong)
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For severe, disseminated, visceral or CNS involvement, doses of up to 10 mg/kg every 8 hours intravenously should be initiated (with adjustment for reduced GFR) (High, Strong)
and continued for at least 14 days.
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Nucleoside inhibitor resistance is suspected based on lack of response to treatment, at which point foscarnet (High, Strong)
therapy should be considered.
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Suppressive therapy can be safely continued for many years and is associated with less frequent acyclovir‐resistant HSV than episodic therapy in immunocompromised patients and thus is the preferred approach. (Moderate, Strong)
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PREVENTION
Patients on antivirals for CMV prevention with activity against HSV do not need additional antiviral prophylaxis. (Moderate, Strong)
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HSV‐specific prophylaxis should be considered for all HSV‐1– and HSV‐2–seropositive organ recipients who are not receiving antiviral medication for CMV replication. (Moderate, Strong)
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Antiviral prophylaxis should continue for at least a month. (Low, Weak)
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Persons may acquire HSV from asymptomatic individuals so care should be taken in intimate contact, particularly during periods of most intense immune suppression. (Low, Weak)
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In serodiscordant couples, daily antiviral therapy taken by the seropositive partner can prevent HSV‐2 transmission to the seronegative partner. (Moderate, Strong)
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Resumption of prophylaxis can be considered for patients being treated for rejection (with T‐cell–depleting agents). (Low, Weak)
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Title
Herpes Simplex Virus Infections In Solid Organ Transplantation
Authoring Organization
American Society of Transplantation
Publication Month/Year
March 12, 2019
External Publication Status
Published
Country of Publication
US
Document Objectives
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of HSV in the pre‐ and post‐transplant period.
Target Patient Population
Solid organ transplant patients
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Operating and recovery room, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Prevention, Management, Treatment
Diseases/Conditions (MeSH)
D014180 - Transplantation, D019737 - Transplants, D000998 - Antiviral Agents, D016377 - Organ Transplantation, D006561 - Herpes Simplex
Keywords
antiviral, prevention, prophylaxis, antimicrobial prophylaxis, solid organ transplant, herpes simplex virus
Source Citation
Lee, DH, Zuckerman, RA; on behalf of the AST Infectious Diseases Community of Practice. Herpes simplex virus infections in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019; 33:e13526.