valacyclovir and Ulcer

To demonstrate a causal relationship between herpes simplex virus 2 (HSV-2) and increased genital HIV-1-RNA shedding in women on HAART.. A randomized, double-blind, placebo-controlled trial of herpes-suppressive therapy (valacyclovir 500 mg twice a day) in HIV-1/HSV-2-infected women taking HAART in Burkina Faso.. Participants were followed for a total of 12 biweekly visits before and after randomization. The presence and frequency of genital and plasma HIV-1 RNA, and of genital HSV-2 were assessed using summary measures, adjusting for baseline values. Random effect linear regression models were used to assess the impact of treatment on genital and plasma viral loads among visits with detectable virus.. Sixty women were enrolled into the trial. Their median CD4 lymphocyte count was 228 cells/mul, and 83% had undetectable plasma HIV-1 RNA at baseline. Valacyclovir reduced the proportion of visits with detectable genital HSV-2 DNA [odds ratio (OR) 0.37, 95% confidence interval (CI) 0.13, 1.05], but had no significant impact on the frequency (OR 0.90, 95% CI 0.31, 2.62) or quantity (reduction of 0.33 log copies/ml, 95% CI -0.81, 0.16) of genital HIV-1 RNA. However, according to pre-defined secondary analyses restricted to women who shed HIV-1 at least once in the baseline phase, valacyclovir reduced both the proportion of visits with detectable HIV-1 shedding (OR 0.27, 95% CI 0.07, 0.99) and the quantity of genital HIV-1 RNA during these visits (-0.71 log10 copies/ml, 95% CI -1.27, -0.14).. HSV-2 facilitates residual genital HIV-1 replication among dually infected women taking HAART despite HIV-1 suppression at the systemic level.

Topics: Acyclovir; Adult; Antiretroviral Therapy, Highly Active; Antiviral Agents; DNA, Viral; Double-Blind Method; Female; Genitalia, Female; Herpes Genitalis; HIV Infections; HIV-1; Humans; Middle Aged; RNA, Viral; Ulcer; Valacyclovir; Valine; Viral Load

A 42-year-old woman with a history of cholangiocarcinoma on adjuvant chemotherapy with capecitabine presented with painless haematochezia. She was found to have an isolated twenty-five mm ulcer in the ascending colon. Biopsies of the ulceration demonstrated typical cytomegalovirus (CMV) inclusions and her peripheral blood CMV PCR was significantly elevated. This is an unusual case of a solitary proximal colon ulcer. Non-steroidal anti-inflammatory drugs, inflammatory bowel disease and malignancy, are the most frequent causes of isolated ulcers in the proximal colon. Gastrointestinal (GI) CMV disease most commonly causes CMV colitis and is considered rare outside of the transplant population and other severely immunosuppressed patient groups. Patients who have received chemotherapy may also be at risk for GI CMV disease. The diagnosis should be suspected in patients who present with haematochezia or watery diarrhoea within a broad window of time after receiving chemotherapy.

Topics: Adult; Antimetabolites, Antineoplastic; Antiviral Agents; Bile Duct Neoplasms; Capecitabine; Chemotherapy, Adjuvant; Cholangiocarcinoma; Colitis; Colon, Ascending; Cytomegalovirus Infections; Female; Gastrointestinal Hemorrhage; Humans; Immunocompromised Host; Pancreaticoduodenectomy; Risk Factors; Ulcer; Valacyclovir

Topics: Adult; Antiviral Agents; Biopsy; Diagnosis, Differential; Ear Diseases; Ear, External; Female; Herpes Simplex; Humans; Patient Care Management; Treatment Outcome; Ulcer; Valacyclovir

A 24-year-old transgender woman consulted our outpatient clinic with a painful, itchy and red left labia. She underwent a penile inversion vaginoplasty 18 months before presentation. At physical examination of the left labia, erythema, edema and herpetic vesicles with ulceration were observed. A vesicle fluid swab was obtained and the presence of herpes simplex virus type 1 (HSV-1) was detected by PCR assay. Treatment consisted of oral valaciclovir (500 mg twice daily) for a total of five days.Topically-applied lidocaine cream (3%) was used for pain management. Treatment gave symptom relief in five days. At physical examination 14 days after symptom onset, there were no signs of active infection. To our knowledge, this is the first case report of HSV-1 infection of the neolabia in a transgender woman.

Topics: Acyclovir; Administration, Topical; Antiviral Agents; Female; Herpes Genitalis; Herpesvirus 1, Human; Humans; Lidocaine; Male; Transgender Persons; Treatment Outcome; Ulcer; Valacyclovir; Valine; Young Adult

Topics: Acyclovir; Aged; Antiviral Agents; Deglutition Disorders; Esophagitis; Esophagoscopy; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Ulcer; Valacyclovir; Valine

Herpes simplex virus (HSV) ocular infection causes significant visual burden worldwide. Despite the fact that dendritic or geographic corneal ulcers are typical findings in HSV epithelial keratitis, conjunctival ulcer as a sign of HSV infection has rarely been reported. Although easily overlooked, this important sign could be enhanced by fluorescein staining. We report two cases of conjunctival geographic ulcers proven to be HSV infection by viral isolation and polymerase chain reaction (PCR). One patient had bilateral disease and blepharitis, and the other had unilateral involvement without skin lesions. With timely diagnosis and proper management, excellent visual outcome can be expected.

Topics: Acyclovir; Adult; Antigens, Viral; Antiviral Agents; Blepharitis; Conjunctival Diseases; DNA, Viral; Female; Herpesvirus 1, Human; Humans; Keratitis, Herpetic; Polymerase Chain Reaction; Ulcer; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; Coloring Agents; Conjunctival Diseases; Eye Infections, Viral; Female; Herpes Simplex; Humans; Immunoglobulin G; Lissamine Green Dyes; Simplexvirus; Ulcer; Valacyclovir; Valine

The clinical and histopathological features of cutaneous herpes simplex virus (HSV) infection have been well described. Genital herpetic infections are largely induced by HSV type 2, but 30% of cases can be caused by HSV type 1. Immunocompromised patients are known to exhibit atypical patterns of clinical presentation with variable lesion morphology and anatomic location. A subset of patients may show morphology such as nodules or verrucous lesions. Analogously, some biopsy specimens may show unusual microscopical features, such as a lack of keratinocyte cytopathology, lymphocyte infiltration or vasculopathic changes that are expected irrespective of the patient's immune status. We present the case of a patient carrying a previous diagnosis of pemphigus vulgaris, status posttreatment with methotrexate and prednisone, who developed a perineal ulcer exhibiting significant numbers of plasma cells, many of which were cytologically atypical. This morphology was suggestive of a hematopoietic malignancy. Immunoperoxidase staining for HSV decorated a focal collection of keratinocytes that lacked appreciable viral changes expected of HSV infection.

Topics: Acyclovir; Adult; Antiviral Agents; Dermatologic Agents; Female; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Methotrexate; Pemphigus; Perineum; Plasma Cells; Prednisolone; Skin; Skin Diseases; Ulcer; Valacyclovir; Valine

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Herpes Genitalis; Humans; Male; Penile Diseases; Ulcer; Valacyclovir; Valine

A 34-year-old healthy woman presented with a 15-month history of persistent, nonhealing vulvar ulcerations due to herpes simplex virus (HSV) type 2. Extensive dermatologic workup and serial skin biopsies failed to reveal an underlying vulvar dermatosis or autoimmune bullous disorder. Virologic studies revealed resistance to acyclovir in vitro due to deficiency in thymidine kinase activity. Serum antibody to human immunodeficiency virus was negative on two occasions, separated by 1 year. Immunologic evaluation showed normal HSV-specific proliferative and CD8 cytotoxic T lymphocyte responses as well as normal NK cell function. Vulvar lesions failed to heal in association with trials of topical trifluorothymidine and oral valacyclovir but resolved completely with the application of 1% foscarnet cream. No recurrence of HSV has been observed in 24 months of follow-up to date.

Topics: Acyclovir; Antiviral Agents; Chronic Disease; Drug Resistance, Microbial; Female; Foscarnet; Humans; Immunocompetence; Simplexvirus; Thymidine Kinase; Ulcer; Valacyclovir; Valine; Vulvar Diseases