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03.10.2014

Treatment for herpes simplex, alternative medicine digest (issue 15 1997) - Within Minutes

Author: admin
The following recommendations are based on the 2009 guidelines for prevention and treatment of opportunistic infections[1]. Patients who have frequent or severe recurrences of HSV infections should be considered for suppressive therapy with valacyclovir, famciclovir, or acyclovir(Figure 4.
The treatment of orolabial lesions and genital HSV infection (initial or recurrent) should consist of a 5 to 14 day course of valacyclovir (Valtrex), famciclovir (Famvir), or acyclovir (Zovirax) (Figure 4. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.
Additional support for use of suppressive therapy in HIV-infected patients arose from studies that have shown HSV outbreaks can result in increased HIV transcription and increased genital and plasma HIV RNA levels[12,13]. In the United States, approximately 70% of HIV-infected adults have serologic evidence of established infection with HSV-2 infection and 95% are seropositive for either HSV-1 or HSV-2[1].


For patients with severe mucocutaneous HSV lesions, intravenous acyclovir is recommend for initial therapy, followed by oral therapy when the lesions start to resolve.
These findings correspond with data that show certain HSV regulatory proteins (ICPO, ICP27 and VP16) can induce HIV replication and herpes simplex virions can increase HIV expression in macrophages[14]. For persons co-infected with HIV and HSV, most available data suggest HSV suppressive therapy has a favorable impact on genital and plasma HIV levels[15,16,17,18]. Although most HSV lesions require only 5 to 14 days of therapy, treatment of moderate-to-severe chronic ulcerative HSV lesions usually requires at least 14 days and patients should have close follow-up.
In general, these patient should receive therapy for HSV until the lesions have completely healed[10]. In one study that involved HSV suppressive therapy for HIV and HSV co-infected women in Africa on highly active antiretroviral therapy, the women had reduced genital shedding of HSV, but no significant decrease in plasma HIV RNA levels.


If the patient has received multiple courses of therapy for recurrent HSV infection, or is taking chronic HSV suppressive therapy when new lesions develop, greater consideration should be given to possible acyclovir-resistant HSV. Two large clinical trials investigated the impact of suppressive herpes therapy on HIV acquisition in HIV-negative, HSV-2 co-infected individuals, but found no benefit of suppressive therapy[19,20].
Evaluation and treatment of acyclovir-resistant HSV infection is discussed in Case 2 in this Dermatologic Manifestations module.



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