When genital herpes fails to respond to standard antiviral therapy in the context of severe immunodeficiency, a distinct clinical protocol applies. This page outlines the clinical scenario and points to the full structured protocol.
This protocol addresses drug-resistant or clinically refractory genital herpes occurring in a severely immunocompromised individual, including those with late-stage HIV. Although refractory genital HSV lesions are rare among immunocompetent patients, they represent a major clinical problem in the setting of severe immunodeficiency.
Management in this specific setting may involve immunomodulatory therapy for certain lesion types, or agents from a novel antiviral class that targets a different mechanism than conventional antivirals — an approach that has shown considerable promise in immunocompromised patients with refractory disease. Full selection criteria, options, and the complete regimen are available in the protocol.
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.
Immunomodulators, such as topical imiquimod, or thalidomide, can be useful in treating this condition.
Reports of outcomes in the open access pritelivir programme for immunocompromised people living with refractory lesions has shown great promise for this novel helicase primase inhibitor.
Amenamevir (a helicase-primase inhibitor, currently licensed for the treatment of herpes zoster) has also been used for this indication.
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