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MANAGEMENT
OF OPPORTUNISTIC INFECTIONS
IN
HIV-POSITIV PATIENTS
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FACT
SHEETS
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Herpes
simplex
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A viral infection
Causative organisms
Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2)
Symptoms of active infection
Anogenital herpes
Lesions are usually caused by HSV-2 and may be seen
as clusters of small vesicles or as single or multiple
small or large confluent ulcers of the buttocks, perineum,
scrotum, vulva or penis. Rarely herpes may involve the
rectum and be seen as proctitis with rectal pain and
tenesmus.
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Typical grouped vesicular lesion of herpes simplex are
seen at an unusual site in early stage HIV disease.
Scars of previous attack of herpes simplex are seen
in the same region. Differential diagnosis includes
recurrent herpes zoster affecting the same dermatome
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Orolabial herpes
Lesions may be caused by HSV-1 or 2 and be seen as clusters
of small vesicles or as single or multiple small or large
ulcers of the lips, nose or oral mucosa.
Other manifestations
Herpes oesophagitis is a rare complication of AIDS and
appears identical to CMV oesophagitis with odynophagia.
Oesophageal ulcers are observed on endoscopy. Very rarely,
cases of HSV myelitis, encephalitis and retinitis have
been reported.
Diagnostic procedures
Visual examination, tissue culture
Treatment
Oral acyclovir, 200 to 400 mg orally 5 times per day for
10-14 days or until the lesions have become crusted over
is very effective for the treatment of mucocutaneous herpes
disease.
In patients with severe disease or who are unable to take
oral medications, intravenous acyclovir
5 mg/kg q 8 hours for 10-14 days should be used.
Recurrence
Recurrent disease treatment with acyclovir is individualized
to the patient's needs.
Suppressive therapy
Continuous suppressive therapy should be considered for
patients who have frequent symptomatic recurrent infections.
Frequent recurrences are usually defined as three or more
outbreaks in a 6-month period of time. Acyclovir at a
dose of 400 mg orally twice daily is the treatment of
choice for suppressive therapy.
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