Chronic erosive herpes simplex virus infection of the penis, a possible immune reconstitution disease.
OBJECTIVE
To report a novel clinical presentation: a chronic erosive herpes simplex virus (HSV) infection of the penis which developed in AIDS patients following the commencement of highly active antiretroviral therapy (HAART). The lesions were unresponsive to antiviral treatments which had previously been effective, and this could not be accounted for in terms of increased antiviral resistance.


METHODS
Detailed case-note review and investigation of three cases which presented at two large HIV units in London.


METHODS
Review of all histology with immunohistochemistry for HSV, HSV drug susceptibility assays, tissue typing and measurement of in vitro lymphocyte functional activity against HSV.


RESULTS
The histology of the lesions was the same in each case, with the presence of HSV on immunohistochemistry and an unusual prominence of plasma cell and eosinophils in the inflammatory infiltrate. HSV-specific lymphoproliferative responses were normal in two cases, but subnormal in a third case. All individuals shared the HLA class I molecules B72 and Cw0202 and the class II allele DRB4.


CONCLUSIONS
We believe this to be a previously unreported adverse consequence of HAART, the result of partial immune restoration, reminiscent of the the recently described syndrome of immune recovery vitritis.
Fox
P A
PA
Department of HIV/Genito-urinary Medicine, Chelsea & Westminster Hospital, 369 Fulham Rd, London SW10 9NH, UK.
Barton
S E
SE
Francis
N
N
Youle
M
M
Henderson
D C
DC
Pillay
D
D
Johnson
M A
MA
Fearfield
L
L
Gazzard
B G
BG
Bunker
C B
CB
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002908:Chronic Disease; D006558:Herpes Genitalis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000473:pathology; D016896:Treatment Outcome