This protocol covers the first-ever episode of genital herpes in a patient who is living with HIV. The co-existence of HIV is the defining feature of this scenario and shapes both the treatment approach and the criteria for a satisfactory clinical response.
HIV is the central comorbidity in this presentation. There is no trial data for any antiviral specifically in initial-episode genital HSV in people living with HIV, which makes structured, evidence-guided management especially important for this population.
Oral antiviral therapy is the basis of management in this setting. Several agents and schedules are considered, with the choice and duration determined by the clinical picture and the patient's response. The full protocol details which options apply and when.
Treatment aims for re-epithelialization of all genital lesions, with no new lesions forming by Days 3–5. In this population, the course required to reach these endpoints may extend beyond what is standard for HIV-negative patients.
DOI: 10.1111/jdv.20450
There is no trial data for any antiviral in initial episode genital HSV in people living with HIV.
Treatment should be given for at least 10 days or until all lesions have re-epithelialized — this will often exceed the usual 10-day duration of treatment that is given to HIV-negative patients.
In patients living with advanced HIV, double the standard dose of antiviral should be considered and if new lesions continue to form at Days 3–5, a higher dose should be considered.
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