acyclovir and Hypertrophy

Herpes Simplex Virus type 2 is the primary cause of genital ulceration worldwide. The presence of atypical features like deep ulcerations, hypertrophic, or pseudotumoural lesions or unusual location can be a marker for co-infection with HIV. These immunocompromised patients are usually resistant to the conventional antiviral treatment. We present a case of an HIV-infected patient with hypertrophic herpes genitalis, refractory to conventional oral antiviral therapy, who was successfully treated with a combination of oral valcyclovir and topical application of 5% imiquimod.

Topics: Acyclovir; Adjuvants, Immunologic; Administration, Topical; Aminoquinolines; Antiviral Agents; Drug Therapy, Combination; Herpes Genitalis; HIV Infections; Humans; Hypertrophy; Imiquimod; Immunocompromised Host; Male; Middle Aged; Valacyclovir; Valine

Atypical presentations of herpes simplex genitalis are becoming more frequent. The aim of this study was to investigate the atypical clinical manifestations and treatment of this infection.. The charts of patients with herpes simplex genitalis who attended our clinics between January 2009 and December 2013 were reviewed retrospectively.. Of 294 patients, 147 (50%) were male with a mean (standard deviation, SD) age of 48.3 (16.8) years. An ulcerative lesion was the most common symptom (48.3%), followed by vesicle clusters (36.4%). The mean duration of symptoms at first visit was 6 days. Oral acyclovir was administered to 87.6% of patients. Hypertrophic manifestations were observed in 4.8% (14/294) of patients; 50% (7/294) were male, with a mean age of 44.5 (SD 9) years. All patients with hypertrophic manifestations were infected with HIV. Hypertrophic manifestations had a mean duration of onset of 53.3 days. Acyclovir was prescribed to 11 (78.6%) patients. The mean duration to cure was 40.9 days. Topical imiquimod was given in six resistant cases (42.9%) as adjunctive therapy.. Atypical manifestations of herpes simplex genitalis require careful consideration because their frequency is rising, particularly in patients with HIV infection. Although acyclovir is important in their treatment, imiquimod provides an additional benefit in resistant cases.

Topics: Acyclovir; Adjuvants, Immunologic; Adult; Aged; Aminoquinolines; Antiviral Agents; Coinfection; Drug Therapy, Combination; Female; Herpes Genitalis; HIV Infections; Humans; Hypertrophy; Imiquimod; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Ulcer

Hypertrophic pseudo tumoral herpetic lesion is an uncommon presentation in immunocompromized hosts that can be refractory to established therapies. We describe bipolar anal and tonsilar herpetic tumoral lesions related to acyclovir-resistant HSV-2 in a human immunodeficiency virus-infected patient. Treatment with valacyclovir, cidofovir, and thalidomide failed and surgical excision was required.

Topics: Acyclovir; Animals; Antiretroviral Therapy, Highly Active; Antiviral Agents; Anus Diseases; Chlorocebus aethiops; Drug Resistance, Viral; Herpes Simplex; Herpesvirus 2, Human; HIV Infections; Humans; Hypertrophy; Male; Middle Aged; Palatine Tonsil; Pharyngeal Diseases; Vero Cells

Topics: Acyclovir; Administration, Oral; Adult; Antiretroviral Therapy, Highly Active; Antiviral Agents; Diagnosis, Differential; Female; Herpes Genitalis; HIV Infections; Humans; Hypertrophy; Injections, Intravenous; Papillomavirus Infections; Simplexvirus; Vulva

Five patients (4 males; mean age, 46.4 years) with painful verrucous perianal lesions caused by herpes simplex virus are described. All patients had had AIDS for a long time and were using highly active antiretroviral therapy. CD4+ counts ranged from 73 to 370/mm3. All lesions were submitted to resection under subdural anesthesia. Histologic examinations revealed epithelial hyperplasia and dense inflammatory process, composed mainly of lymphocytes and plasma cells, extended just to the hypodermis. Immunohistochemistry was positive for herpes simplex virus Type 2 in four patients and for herpes simplex virus Type 1 in one patient, and did not detect human papillomavirus antigens. Three patients had recurrences after 3, 10, and 12 months. Resection was performed on two patients; one had a new recurrence after three months. Oral acyclovir eliminated the lesion in the third patient. The analysis of our patients suggests that herpes simplex virus, Types 1 and 2, may cause verrucous lesions simulating neoplasia in patients with AIDS using antiretroviral therapy.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Anal Canal; Anus Neoplasms; Diagnosis, Differential; Female; Herpes Simplex; Humans; Hypertrophy; Immunohistochemistry; Inflammation; Male; Middle Aged; Recurrence