Use of short-course oral amenamevir (helicase-primase inhibitor) for the treatment of thymidine analogue-resistant herpes simplex lesions

Herpes simplex virus (HSV) resistance is rare, but incidence is rising. Managing resistant HSV phenotypes in individuals living with human immunodeficiency virus (HIV) poses an increasing challenge. Here, we present two (2) cases where a short course of oral amenamevir (helicase-primase Inhibitor) for the treatment of thymidine analogue-resistant herpes simplex lesions.Case presentationsCase 1: 55-year-old Liberian man living with HIV presented with an enlarging, hypertrophic lesion on his inner thigh. This had been diagnosed as HSV-2 by PCR. Despite treatment with acyclovir, the lesion persisted. It had also failed to respond to topical therapies and cidofovir. Further molecular diagnostics showed that it was thymidine analogue-resistant HSV. A novel oral, anti-viral agent, amenamevir was used with success.Case 2A 37-year-old Ghanaian woman living with HIV presented with recurrent painful confirmed HSV-2 genital ulceration. Despite escalating treatment from acyclovir to cidofovir, the HSV lesions failed to respond. A seven-day course of oral amenamevir provided excellent resolution of the lesions.ConclusionThese two cases highlight the challenges in managing aciclovir-resistant herpes simplex lesions and the swift resolution following treatment with a novel therapeutic agent, amenamevir. Early recognition of resistant HSV lesions allows for prompt outsourcing of alternative, novel anti-viral therapies such as amenamevir.