Herpes Simplex Virus Infections In Solid Organ Transplantation

Publication Date: March 12, 2019
Last Updated: March 14, 2022

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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Recommendation Grading

Overview

Title

Herpes Simplex Virus Infections In Solid Organ Transplantation

Authoring Organization

American Society of Transplantation

Publication Month/Year

March 12, 2019

Last Updated Month/Year

January 29, 2024

Document Type

Guideline

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.