Treatment of Drug-Resistant or Clinically Refractory Genital Herpes in Severely Immunocompromised Patients

Managing genital herpes becomes substantially more challenging when lesions fail to respond to standard therapy in patients with severe immunodeficiency. This protocol addresses that specific scenario — drug-resistant or clinically refractory disease in the context of profound immune compromise, including late-stage HIV infection.

Clinical scenario: Although rarely encountered in immunocompetent individuals, clinically refractory genital herpes lesions are a recognised and serious problem in patients with severe immunodeficiency, including late-stage HIV. In this population, standard antiviral approaches may be insufficient, and an alternative therapeutic strategy is required.

Approach at a glance: The structured protocol involves systemic antiviral therapy targeting drug-resistant HSV — including agents active against resistant strains. Management of subsequent recurrences may also incorporate a specific alternating-course strategy. Full sequencing, agent selection rationale, and practical guidance are available in the complete protocol.

Complete regimen details, dosing guidance, and the full clinical algorithm are in the protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/jdv.20450

Although rare in immunocompetent individuals, clinically refractory lesions due to genital HSV are a major problem in patients with severe immunodeficiency, including late-stage HIV.

Systemic therapy with either foscarnet or cidofovir is generally preferred to treat drug-resistant herpes in those living with HIV.

There is evidence for alternating courses of treatment with aciclovir and cidofovir for subsequent recurrences as a strategy that may reduce the development of cidofovir-resistant strains.

View source ↗