Pulmonary Herpes Simplex Virus Reactivation in Invasively Mechanically Ventilated Patients With COVID‐19 in Intensive Care Unit
Abstract
Patients in intensive care units (ICU) under mechanical ventilation, particularly those with SARS‐CoV‐2 infection, are highly susceptible to Herpes simplex virus (HSV) reactivation. Given the lack of data on the SARS‐CoV‐2 Omicron and Delta variants, this study aimed to assess the prevalence of pulmonary HSV reactivation in mechanically ventilated patients with SARS‐CoV‐2 pneumonia. The impact of HSV replication on SARS‐CoV‐2 replication, and conversely, was investigated, along with the susceptibility of HSV strains to antiviral therapies. This retrospective study included 381 mechanically ventilated ICU patients in Lyon. Overall, 103 patients (27.0%) experienced HSV reactivation, with a trend toward a higher prevalence among SARS‐CoV‐2‐positive patients (32.8%) compared to SARS‐CoV‐2‐negative (24.1%; p value = 0.058). HSV reactivation was significantly higher with the Delta variant (46.2%) compared to Omicron (27.1%; p value = 0.045); the Delta variant was associated with a 2.38‐fold increased risk of HSV reactivation. HSV‐positive patients exhibited a 1‐log lower SARS‐CoV‐2 viral load compared to HSV‐negative patients, a finding indicative of the natural course of SARS‐CoV‐2 infection followed by HSV reactivation, rather than viral interference. Unexpectedly, acyclovir resistance mutations appeared in the UL23 gene in at least 13.6% of HSV‐1 strains in patients with an HSV load above 10 5 copies/mL. Complementary phenotypic and genotypic approaches allowed to identify three novel substitutions in UL30 : Q217R, D741A, and E756K, classified as polymorphisms. Further optimization is needed in the management of mechanically ventilated ICU patients with pulmonary HSV reactivation, especially regarding antiviral resistance testing.
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BibTeX
@article{zarlenga2026pulmonary,
title = {{Pulmonary Herpes Simplex Virus Reactivation in Invasively Mechanically Ventilated Patients With COVID‐19 in Intensive Care Unit}},
author = {Bastien Zarlenga and Florent Wallet and Alexandre Gaymard and Anne-Claire Lukaszewicz and Gregory Destras and Christophe Ginevra and Bruno Simon and Jennifer Giorgi and Muriel Rabilloud and Salomé Avenas and Alexis Trecourt and Geneviève Billaud and Florence Morfin and Jean-Christophe Richard and Emilie Frobert and Anne‐claire Lukaszewicz and Jean‐Christophe Richard},
journal = {Journal of Medical Virology},
year = {2026},
month = oct,
doi = {10.1002/jmv.71170},
url = {https://hal.science/hal-05862005v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Pulmonary Herpes Simplex Virus Reactivation in Invasively Mechanically Ventilated Patients With COVID‐19 in Intensive Care Unit
AU - Bastien Zarlenga
AU - Florent Wallet
AU - Alexandre Gaymard
AU - Anne-Claire Lukaszewicz
AU - Gregory Destras
AU - Christophe Ginevra
AU - Bruno Simon
AU - Jennifer Giorgi
AU - Muriel Rabilloud
AU - Salomé Avenas
AU - Alexis Trecourt
AU - Geneviève Billaud
AU - Florence Morfin
AU - Jean-Christophe Richard
AU - Emilie Frobert
AU - Anne‐claire Lukaszewicz
AU - Jean‐Christophe Richard
PY - 2026
DA - 2026/10/07
JO - Journal of Medical Virology
DO - 10.1002/jmv.71170
UR - https://hal.science/hal-05862005v1
AB - Patients in intensive care units (ICU) under mechanical ventilation, particularly those with SARS‐CoV‐2 infection, are highly susceptible to Herpes simplex virus (HSV) reactivation. Given the lack of data on the SARS‐CoV‐2 Omicron and Delta variants, this study aimed to assess the prevalence of pulmonary HSV reactivation in mechanically ventilated patients with SARS‐CoV‐2 pneumonia. The impact of HSV replication on SARS‐CoV‐2 replication, and conversely, was investigated, along with the susceptibility of HSV strains to antiviral therapies. This retrospective study included 381 mechanically ventilated ICU patients in Lyon. Overall, 103 patients (27.0%) experienced HSV reactivation, with a trend toward a higher prevalence among SARS‐CoV‐2‐positive patients (32.8%) compared to SARS‐CoV‐2‐negative (24.1%; p value = 0.058). HSV reactivation was significantly higher with the Delta variant (46.2%) compared to Omicron (27.1%; p value = 0.045); the Delta variant was associated with a 2.38‐fold increased risk of HSV reactivation. HSV‐positive patients exhibited a 1‐log lower SARS‐CoV‐2 viral load compared to HSV‐negative patients, a finding indicative of the natural course of SARS‐CoV‐2 infection followed by HSV reactivation, rather than viral interference. Unexpectedly, acyclovir resistance mutations appeared in the UL23 gene in at least 13.6% of HSV‐1 strains in patients with an HSV load above 10 5 copies/mL. Complementary phenotypic and genotypic approaches allowed to identify three novel substitutions in UL30 : Q217R, D741A, and E756K, classified as polymorphisms. Further optimization is needed in the management of mechanically ventilated ICU patients with pulmonary HSV reactivation, especially regarding antiviral resistance testing.
SN - 0146-6615
SN - 1096-9071
ER -