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HSV1+ and HIV+.....need advice
Sep 6, 2000

I wrote in a few days ago and haven't seen a response yet, so I thought I would try again. I really need some advice. I am HIV+....since 1995. I am not currently on any HIV meds. My latest CD4 is 795, CD8 is 1100 and VL is 300. I became infected with HSV1 herpes genitally and orally about 10 months ago (I have been tested - positive for type 1, negative for type 2). I have never had a blister or lesion, but I have plenty of itching, burning and stinging - genitally and orally. Initially, I had these symptoms about every 2 months. About 6 months ago after being vaccinated for Hep A, my HSV1 herpes symptoms started happening EVERYDAY, ALL THE TIME - orally and genitally (still no lesions or blisters though). And this has persisted for six months. I tried Acyclovir and Famvir which reduced the symptoms some, but not completely. Why am I experiencing symptoms all the time, despite a relatively strong immune system? What advice can you give me regarding treatment? Should I go HAART in hopes that my immune system will then do a better job of controlling the HSV1. I am not in any pain, but I want to be able to date and I am afraid that there is a very high likelihood that I will give someone herpes, because my herpes is in a constant state of activation. I am afraid to even kiss anybody!! Please help....I need advice on what to do!!

Response from Dr. Pavia

This is a complicated one. We know that people can have recurrences without actually getting blisters or lesions, and still shed virus, but usually these outbreaks are mixed with typical outbreaks. If you really were infected with type 1 and not type 2 (the blood tests are often unreliable unless sent to a few reference labs which use a more sophisticated way of telling them apart), the frequent recurrences are much less common.

The other thing that bothers me is the lack of a complete response to Valtrex or Famvir. These should lead to good control within a week, although it may recur when the drugs are stopped. I wonder if the symptoms you are having now could be due to something other than herpes. Possibilities include a fungal infection, a dermatological condition, or even a high level of anxiousness about the herpes returning.

I don't think HAART is a good idea. I would think about having cultures or even PCR for Herpes done of the areas that are symptomatic. If these are negative, it would argue strongly against herpes and it would be time to consider other diagnoses.

Suppressive therapy, usually acyclovir (zovirax) 400-800 mg twice a day is very helpful for people who have outbreaks very frequently (say more than 6/year) and may improve quality of life and even may have some effect on lowering HIV viral load in some people.

Good luck

ATP

Andrew T. Pavia, M.D.



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