11th Annual Conference Of The British HIV Association [BHIVA]

20–23 April 2005, Burlington Hotel·Dublin·Ireland


[AUTHOR(S):] A Holmes, M McMenamin, C Bergin, F Mulcahy
St. James’s Hospital, Dublin, Ireland

BHIVA Conf 2005 Apr 20-23;11:PA8

AIM: Description of 3 cases of Hypertrophic Herpes Simplex Genitalis [HSV] in HIV 1 infected patients.

CASES: One 30 year-old Congolese man. 3-year history of HIV, on antiretroviral therapy [ART], viral load [VL] <50cpm, CD4 >400 × 106/l. Recurrent genital ulceration despite Valacyclovir prophylaxis. He developed multiple disfiguring hypertrophic lesions of the penis and perineum. No response to Foscarnet or Cidofovir. TK mutation negative. Excellent response to Thalidomide/ Valacyclovir combination.

2: 48 year old Rwandan woman. 7-year diagnosis of HIV, VL<50cpm on ART. CD4 count <200 × 106/l. Dapsone as PCP prophylaxis. Recurrent HSV 2 initially responded to episodic Valacyclovir, but progressed to hypertrophic lesions. No response to Cidofovir; relapse within weeks of Foscarnet. Trials of Valgancyclovir and Thalidomide unsuccessful.

Histology at vulvectomy: VIN 3.

3: 34-year-old Ugandan woman. 2-year diagnosis of HIV, on ART with a CD4 > 500 × 106/l.Genital ulceration treated episodically with Valacyclovir; culture negative. Developed hypertrophic labial and perineal lesions.

HISTOLOGY: Marked lymphocytic, plasmacytic and eosinophilic infiltrates and immunohistochemistry positive for HSV.

DISCUSSION: Hypertrophic HSV is unusual, even in the setting of HIV [3/1200 in our cohort, all African], difficult to treat, and may predispose to dysplastic changes.


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