RT Journal Article SR Electronic T1 Phenotypic and Genotypic Antiviral Resistance Testing of HSV-1 Causing Recurrent Cutaneous Lesions in a Patient with DOCK8 Deficiency JF bioRxiv FD Cold Spring Harbor Laboratory SP 808303 DO 10.1101/808303 A1 Amanda M. Casto A1 Sean C. Stout A1 Rangaraj Selvarangan A1 Alexandra F. Freeman A1 Brandon D. Newell A1 Erin D. Stahl A1 Alexander L. Greninger A1 Dwight E. Yin YR 2019 UL http://biorxiv.org/content/early/2019/10/17/808303.abstract AB Antiviral resistance frequently complicates treatment of herpes simplex virus (HSV) infections in immunocompromised patients. Here we review the case of an adolescent boy with dedicator of cytokinesis 8 (DOCK8) deficiency, who experienced recurrent infections with resistant HSV-1. We used both phenotypic and genotypic methodologies to characterize the resistance profile of HSV-1 in the patient and conclude that genotypic testing outperformed phenotypic testing. We also present the first analysis of intrahost HSV-1 evolution in an immunocompromised patient. While HSV-1 can remain static in an immunocompetent individual for decades, the virus from this patient rapidly acquired genetic changes throughout its genome.