异基因造血干细胞移植 (HSCT) 受者中的单纯疱疹病毒 (HSV) 感染带来了重大挑战，其发病率、严重程度更高，并且由于 T 细胞介导的免疫受损而出现抗病毒药物耐药性的风险。本文献综述重点关注 HSCT 受者中阿昔洛韦难治性/耐药性 HSV 感染。该综述讨论了抗病毒预防的有效性、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预后影响的确定。此外，还讨论了替代治疗方案。虽然阿昔洛韦预防治疗在减少 HSCT 受者的 HSV 感染以及在某些情况下总体死亡率方面具有显着益处，但人们仍担心出现耐药 HSV 菌株。我们的系统评价报告显示，阿昔洛韦耐药 HSV 感染的中位发病率为 16.1%，近年来有上升趋势。尽管现有研究存在局限性，HSV 对阿昔洛韦产生耐药性的潜在危险因素包括人类白细胞抗原 (HLA) 不匹配、骨髓肿瘤和急性白血病以及移植物抗宿主病 (GVHD)。有限的证据表明，患有阿昔洛韦难治/耐药 HSV 感染的同种异体 HSCT 受者的预后可能较差。替代治疗方法，如膦甲酸、西多福韦、局部西多福韦、优化阿昔洛韦剂量和解旋酶引物酶抑制剂提供了有希望的选择，但需要进一步研究。总体而言，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，并确定那些风险较高的人群。© 2024 作者。约翰·威利 (John Wiley) 发表的《医学病毒学评论》

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.© 2024 The Author(s). Reviews in Medical Virology published by John Wiley & Sons Ltd.