The role of anti-HSV therapeutics in the HIV-infected host and in controlling the HIV epidemic.
The management of genital herpes in patients co-infected with human immunodeficiency virus (HIV) varies considerably from those without HIV infection. The International Herpes Management Forum (IHMF) has published guidelines for the diagnosis and management of herpes simplex virus (HSV) infection in the HIV-infected host. In 2004, these recommendations were supplemented after consideration of the most recent research conducted in this field, which adds to the growing body of evidence linking the epidemics of HSV-2 and HIV-1 infection. This article presents the supporting evidence for these recommendations and statements. Recent studies suggest that HSV-2 infection may elevate viral load during HIV-1 infection and hence lead to accelerated disease progression. It therefore seems logical to offer suppressive antiviral therapy routinely to HIV-positive patients. This approach is supported by studies demonstrating the safety and efficacy of HSV antiviral therapy in individuals co-infected with HSV and HIV. The question remains whether HSV antiviral therapeutics reduce the risk of HIV acquisition and transmission. Clinical trials are being conducted to address this question. HSV type-specific serological testing is warranted in those who are infected with, or who are at high risk of acquiring, HIV infection. However, in developing countries and resource-poor settings, their utility is less clear for a number of reasons. These aspects are also discussed.
Barton
Simon
S
Chelsea and Westminster Hospital, London, UK. simon.barton@chelwest.nhs.uk
Celum
Connie
C
Shacker
Timothy W
TW
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D023241:Antiretroviral Therapy, Highly Active; D015497:HIV-1; D006558:Herpes Genitalis / Q000188:drug therapy*; D006801:Humans; D016867:Immunocompromised Host