OPPORTUNISTIC INFECTIONS IN HIV
#002… HERPES SIMPLEX
HERPES disease is caused by type 1 and 2 herpes simplex viruses. These are common in most sexually active people and can also be transmitted from mother to child during birth. most people live through their lives without having a clinical manifestation because their immunity keep the virus in check. Flares and subsequent clinical manifestations therefore occur after exposure to sunlight or during periods of lowered immunity from stress, poor nutrition, drugs or other diseases.
Herpes simplex 1 (HSV-1) classically manifests in the mouth region after a period of pain, as a boil or vesicle, then to ulcer before healing up. In people with high or normal immunity, it usually runs a short course of 5 to 10 days, while in the immunocompromised it can last for months, and cover more extensive surfaces.
Herpes simplex 2(HSV-2) however, manifests typically around the genital area. Their lesions are usually ulcerative in mucosal surfaces and vesicular in skin surfaces. In people with very low cd4 count (usually <100 cells per ml), deep non-healing ulcers may occur, or atypical hypertrophic lesions which mimic cancers.
CLINICAL IMPLICATIONS OF HERPES DISEASE FOR PLHIV (people living with HIV)
- Herpes especially type 2, tends to increase HIV viral load
- It tends to decrease CD4 count
- It increases likelihood of transmission of HIV between partners and from mother to child, especially when there are active genital sores.
- It can be transmitted to the baby during delivery, and might cause blindness in the child.
- There is more tendency to encounter atypical or disseminated herpes in AIDS.
- Disseminated herpes can be fatal
- Severe Herpes can cause significant morbidity and disfigurement
In people living with HIV, clear diagnosis of suspected lesion using HSV/DNA test is recommended, to show the specific type (either 1 or 2). Also, early presentation to the doctor for diagnosis and treatment is better.
PREVENTION OF EXPOSURE
Due to the above clinical implications, and the need for PLHIV to decrease the disease burden, it is important to protect oneself by;
- Consistent use of latex condom
- Avoid sex when partner has obvious herpetic lesions
- Suppressive antiviral therapy in persons with HIV and an active hsv-2 reduced transmission to heterosexual partners by 48% (this is only recommended for people already on antiretroviral
Most cases of herpes run a self-limiting course, however, in persistent or severe cases, anti-viral like acyclovir, valacyclovir may be prescribed by your doctor.
For acyclovir resistant ones, iv cidofovir, iv foscarnet may be administered by your physician.
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