How are HSV and HZV treated in HIV disease?

Updated: Mar 26, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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For herpes simplex virus (HSV) and herpes zoster virus (HZV) infections in HIV-infected patients, the treatment of choice is acyclovir and other members of this drug class. These agents are activated by viral thymidine kinase. In some disseminated cases, the virus may be resistant to acyclovir because of the deficiency in viral thymidine kinase activity.

Prolonged therapy and chronic suppressive therapy with subtherapeutic doses have also been implicated in the development of acyclovir resistance. In the presence of acyclovir resistance, other viral therapies, including cidofovir, foscarnet, and vidarabine, may be necessary.

Treatment is usually not necessary for patients with oral hairy leukoplakia. If the patient is experiencing significant discomfort, systemic (1200 mg/day) and topical acyclovir, ganciclovir, or foscarnet may be recommended.

In most cases of molluscum contagiosum, imiquimod (Aldara) is curative. Resolution with zidovudine therapy has been reported in HIV-associated molluscum contagiosum. There are isolated reports of the efficacy of cidofovir in several viral infections (eg, molluscum contagiosum, [65] warts, [29] CMV infection) that are frequently observed in HIV-infected patients infected with HIV, but extensive studies of the safety and the efficacy of cidofovir have not been conducted to date.

Ablation and curettage may be useful in the treatment of molluscum contagiosum.

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