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HIV and rectal Herpes
Oct 11, 2003

I am at my wits end. Don't know where to turn. I'm a 42yo gay male - 6'1 185#. In July I was diagnosed with rectal herpes. In August the HIV test results came back positive. T-Cell 462, v-Load 4964. No meds. I have been on Valtrex daily since diagnosed with rectal Herpes. 1 gram a day. I am treating the HIV so far with nutrition and exercise. Optipak plus and Resurgex, and moderate weight training. It's the Herpes that's driving me nuts. Either I have had one very long initial outbreak, or have recurrent outbreaks at the rate of one every 5 days. My lips burn, my right eye itches, my buttocks are constantly sore, my right toes hurt and sometimes my left toes. My GI performed a sigmoscopy and found a polyp and some irratation but said biopsy results showed nothing. My Infectious disease physican says the Herpes are not HIV Related (agreed). States that I should not remain on the Valtrex unless I have a verifiable outbreak. They are worried about resistance. They agreed to give me 3 months of suppressive to allow me time to adjust mentally. However, since I discovered the "gift", I have had no releif at all, not a single days. Being rectal, no one has ever seen the lesions as they are internal if and when they are present. Hate to sound like a whinner, because I normally am not, but the quality of my life has decreased by 60 or better since this began 3 months ago. Could it be nueropathy? Would being placed on HIV meds help even with a low viral load? I'm totally lost and really do not know where to turn next. Lastly, I appericate the site. Wonderful work you all do. "Angels flying close to the ground".

Response from Dr. Holodniy

I am a little confused about how the diagnosis of rectal herpes was made initially. Did they do a rectal biopsy and/or culture to document the infection? Was it the correct diagnosis? Given your current CD4 count, you have a relatively good/intact immune system, so if it was herpes, I would have expected the valtrex to get rid of it. Some people do get recurrent disease and in these cases chronic suppressive therapy is indicated. That does require rebiopsy or culture to confirm the diagnosis of recurrence. Other things can cause genital/rectal ulcer disease and/or pain. If this is documented recurrence, then it would be recommend to start HIV treatment and to get an additional herpes culture to document resistance, in which case other antiherpetic agents might have to be tried. Your other symptoms would be unusual to be coming from a genital herpes infection.



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