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non-HSV1, non-HSV2 herpes coinfections, valtrex, and hiv viral load
Aug 12, 2007

I am hiv positive and I do NOT have HSV-1 or HSV-2 as confirmed by negative serology tests and lack of symptoms in clinical presentation. I was prescribed a 10-day course of Valtrex for treatment of what my physician thought to be an atypical presentation of shingles. It actually turned out to be a Staph infection based on culture results that was treated with Bactrim. My hiv viral load since my diagnosis with HIV in April of 2006 has been anywhere from 150,000 to 300,000 with the last high pre-Valtrex result as 200,000 in February of 2007. The last day of the 10-day Valtrex regimen (March 5, 2007)my hiv viral load was drawn and came back an astonishing 37,000! The lowest it has ever been and I am antiretroviral naive and have been delaying meds until absolutely necessary. My most recent pre-valtrex cd4 was 391 at 18 percent in February 2007 and on the last day of valtrex the cd4 was 429 at 29 percent. I have tested positive for CMV, EBV, and I had chickenpox as a child so I know I have VZV. I have read where Valtrex has at least partial activity against CMV, EBV, and VZV. Is it possible that the Valtrex suppressed these less bandied about non-HSV1, non-HSV-2 Herpes coinfections allowing my immune system to better focus on controlling my hiv viral load? I can't find any literature on this other than for HSV-1 and HSV-2 but it just makes logical biological rationale that suppressing any herpes coinfection would allow for less chronic immune activation to occur which would help reign in HIV production by keeping a check on cd4 production. I am going to ask my doctor to try long term valtrex to see if this works again since my latest viral load went back up to 125,000 from 37,000 now that I am no longer taking Valtrex. I wonder, if this works again, how much more time I could buy myself before needing meds for hiv as opposed to just letting my body fight hiv without assistance from valtrex? How many other patients with non-HSV1, non-HSV2 herpes coinfections could delay meds even longer utilizing this method? The longer meds are delayed, the later the resistance clock starts ticking and the more toxicity-free time you have. At the rate I'm going without valtrex I'm looking at starting meds this year. Have you noticed this phenomenon with Valtrex in your patients with non-HSV1, non-HSV2 herpes coinfections? Dying to know

Response from Dr. Pierone

I don't have any experience with Valtrex suppression of non-HSV infections in HIV-infected patients. For HSV suppression, most of our patients are on acyclovir or Valtrex and both of these medications work quite well.

Your situation is somewhat unusual because most people with HIV infection also have antibodies to HSV. When there is evidence of recurrent herpes infection, there is clear benefit associated with suppression of these outbreaks.

It is difficult to ignore the reduction in viral load which you experienced in relation to Valtrex treatment. Although it is not really possible to know what happened, it would be reasonable to take another course of Valtrex and recheck the viral load. If there is again a significant decline, then long-term suppressive treatment would make sense.

Let us know what happens and how things turn out. Good luck!



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