Herpes simplex virus
Chronic persistent infection with herpes simplex virus (HSV) is common in patients with advanced HIV disease and is a Centers for Disease Control (CDC)-defined index infection in establishing an AIDS diagnosis.
Lesions may appear as grouped blisters that rupture, crust, and heal in 7 to 10 days. Once severely immunosuppressed, HIV-infected persons often experience chronic lesions that continue to expand and form large, painful ulcers and crusted erosions, 2 to 10 cm or larger.
Periungual infection is another characteristic manifestation of HSV-2 infection in the HIV-infected patient; all paronychial lesions should be cultured for HSV.
Fluorescent antibody testing or viral culture of fresh lesions are diagnostic.
Treatment
Acyclovir ( Zovirax, 200 to 400 mg orally 5 times daily) should be prescribed until the ulcers heal, which may take several weeks. Chronic suppressive therapy may be instituted with acyclovir (400 mg orally twice daily) to reduce recurrences. Famciclovir ( Famvir, 250 mg 3 times daily) and valacyclovir ( Valtrex, 100 mg twice daily) have higher bioavailability and require less frequent dosing.
Acyclovir-Resistant HSV Infection. Large chronic perianal, perioral, or periungual ulcers that fail to heal with acyclovir are often caused by acyclovir-resistant HSV-2. Treatment with foscarnet and continuous-infusion acyclovir is beneficial. Trifluridine ophthalmic solution may be effective for lesions that do not respond to acyclovir and foscarnet.
Images:
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