This protocol addresses the initial episode of genital herpes occurring in a person living with HIV. The underlying HIV status shapes both the expected clinical course and the treatment approach. Notably, there is no trial data for any antiviral specifically in initial episode genital herpes in people living with HIV.
First-line management was initiated with oral antiviral therapy — aciclovir, valaciclovir, or famciclovir — for at least 10 days or until all lesions re-epithelialized. Escalation to this protocol is indicated when re-epithelialization of all genital lesions has not been achieved, or when new lesions continue to form at Days 3–5 of treatment.
When oral antiviral therapy is insufficient, the protocol involves a switch to intravenous antiviral therapy for an initial period until clinical improvement is established, followed by oral antiviral treatment to complete the full course. The complete regimen — including agent, sequencing, and duration — is detailed in the full protocol.
Clinical improvement and complete re-epithelialization of all genital lesions.
DOI: 10.1111/jdv.20450
There is no trial data for any antiviral in initial episode genital HSV in people living with HIV.
If fulminant disease ensues, then intravenous aciclovir be substituted at 5–10 mg/kg body weight every 8 h, for 2–7 days or until clinical improvement and followed by oral antiviral therapy to complete a minimum of 10 days total treatment (1, D).
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.
View source ↗