Treatment of genital herpes simplex virus type 2 in HIV-infected patients
- Christine Johnston, MD, MPH
Christine Johnston, MD, MPH
- Assistant Professor of Medicine
- University of Washington
- Anna Wald, MD, MPH
Anna Wald, MD, MPH
- Professor of Medicine, Epidemiology, and Laboratory Medicine
- University of Washington
Genital herpes is a common sexually transmitted virus infection that is found worldwide. Genital herpes is usually secondary to herpes simplex virus type 2 (HSV-2); the remainder of infections is related to HSV-1, which also causes herpes labialis ("cold sores") . The seroprevalence of HSV-2 infections in HIV-infected patients is high (50 to 90 percent) and genital ulcer disease can be more frequent, severe, and of longer duration than in HIV-seronegative patient populations .
This topic will review the treatment of genital herpes in HIV-infected patients. The natural history, clinical manifestations, and prevention of genital HSV infection in the HIV-infected patient and important viral interactions between HIV and HSV-2 are discussed elsewhere. (See "Epidemiology, clinical manifestations, and diagnosis of genital herpes simplex virus in HIV-infected patients" and "Effect of herpes simplex virus on HIV infection: Implications for HIV prevention".)
There are three classification categories for genital herpes, as noted below.
Primary HSV infection — An HSV outbreak is defined as "primary" if the patient was HSV-seronegative for both HSV-1 and HSV-2 at the onset of genital lesions.
Nonprimary HSV infection — Nonprimary first episode infection refers to: a) the acquisition of genital HSV-1 infection in a patient with preexisting antibodies to HSV-2 or b) the acquisition of genital HSV-2 infection in a patient with preexisting antibodies to HSV-1 (eg, an individual with prior orolabial herpes). Most HIV-infected adults with a new diagnosis of HSV infection have nonprimary disease due to prior acquisition of HSV-1 infection.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Primary HSV infection
- Nonprimary HSV infection
- Reactivation (recurrent) disease
- AVAILABLE AGENTS
- TREATMENT OF FIRST EPISODE HSV INFECTION
- TREATMENT STRATEGIES FOR RECURRENT DISEASE
- Episodic therapy
- Suppressive therapy
- CLINICAL TRIAL DATA
- General background
- Limitations of clinical trial data
- Suppressive therapy trials
- Episodic therapy trials
- DRUG INTERACTIONS
- WHICH STRATEGY TO SELECT
- DOSING GUIDELINES FOR ANTIVIRAL THERAPY
- Suppressive therapy
- Episodic therapy
- IMMUNE RECONSTITUTION SYNDROME
- DURATION OF THERAPY
- WHEN TO SUSPECT HSV DRUG RESISTANCE
- SUMMARY AND RECOMMENDATIONS