title: Progressive hypertrophic genital herpes in an HIV-infected woman despite immune recovery on antiretroviral therapy.
abstract: Most HIV-infected individuals are coinfected by Herpes simplex virus type 2 (HSV-2). HSV-2 reactivates more frequently in HIV-coinfected individuals with advanced immunosuppression, and may have very unusual clinical presentations, including hypertrophic genital lesions. We report the case of a progressive, hypertrophic HSV-2 lesion in an HIV-coinfected woman, despite near-complete immune restoration on antiretroviral therapy for up to three years. In this case, there was prompt response to topical imiquimod. The immunopathogenesis and clinical presentation of HSV-2 disease in HIV-coinfected individuals are reviewed, with a focus on potential mechanisms for persistent disease despite apparent immune reconstitution. HIV-infected individuals and their care providers should be aware that HSV-2 may cause atypical disease even in the context of near-comlpete immune reconstitution on HAART.
authors.affiliation: Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, ON, Canada. yudinm@smh.toronto.on.ca
authors.forename: Mark H
authors.initials: MH
authors.lastname: Yudin
authors.forename: Rupert
authors.initials: R
authors.lastname: Kaul
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D000287:Administration, Topical; D000328:Adult; D000634:Aminoquinolines / Q000008:administration & dosage / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000008:administration & dosage / Q000494:pharmacology; D024882:Drug Resistance, Viral; D005260:Female; D017245:Foscarnet / Q000008:administration & dosage / Q000494:pharmacology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1; D006558:Herpes Genitalis / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D018258:Herpesvirus 2, Human / Q000472:pathogenicity*; D006801:Humans; D006984:Hypertrophy; D000077271:Imiquimod; D016896:Treatment Outcome; D014845:Vulvar Diseases / Q000188:drug therapy / Q000473:pathology* / Q000821:virology
chemical_list: D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000998:Antiviral Agents; D017245:Foscarnet; D000077271:Imiquimod
references.citation: Br J Dermatol. 2003 Jul;149(1):216-7
references.pmid: 12890233
references.citation: J Drugs Dermatol. 2003 Apr;2(2):198-201
references.pmid: 12852374
references.citation: AIDS. 1992 Nov;6(11):1317-20
references.pmid: 1361745
references.citation: J Exp Med. 2003 Jan 20;197(2):153-62
references.pmid: 12538655
references.citation: J Eur Acad Dermatol Venereol. 2006 Aug;20(7):887-9
references.pmid: 16898926
references.citation: Clin Infect Dis. 2004 Nov 1;39 Suppl 5:S248-57
references.pmid: 15494896
references.citation: J Eur Acad Dermatol Venereol. 2002 Sep;16(5):511-5
references.pmid: 12428850
references.citation: Herpes. 2004 Apr;11 Suppl 1:24A-35A
references.pmid: 15115627
references.citation: Scand J Infect Dis Suppl. 1985;47:121-7
references.pmid: 3006227
references.citation: Clin Infect Dis. 2006 Feb 1;42(3):418-27
references.pmid: 16392092
references.citation: HIV Med. 1999 Oct;1(1):10-8
references.pmid: 11737324
references.citation: Br J Dermatol. 1996 Apr;134(4):797-800
references.pmid: 8733396
references.citation: J Infect Dis. 2002 Oct 15;186 Suppl 1:S3-28
references.pmid: 12353183
references.citation: Clin Infect Dis. 2007 Jun 1;44(11):e96-9
references.pmid: 17479932
references.citation: Curr Opin Infect Dis. 2003 Apr;16(2):85-9
references.pmid: 12734440
references.citation: JAMA. 1984 Jul 6;252(1):72-7
references.pmid: 6328055
references.citation: J Infect Dis. 2007 Feb 1;195(3):410-5
references.pmid: 17205480
references.citation: J Am Acad Dermatol. 1997 Nov;37(5 Pt 2):860-3
references.pmid: 9366853
references.citation: Pathology. 2001 Nov;33(4):532-5
references.pmid: 11827427
references.citation: AIDS. 2007 Mar 12;21(5):589-98
references.pmid: 17314521
references.citation: Med Trop (Mars). 1999;59(3):279-82
references.pmid: 10701208
references.citation: N Engl J Med. 1981 Dec 10;305(24):1439-44
references.pmid: 6272110
references.citation: Br J Dermatol. 2002 Nov;147(5):1034-6
references.pmid: 12410731
references.citation: Clin Infect Dis. 2007 Feb 1;44(3):e25-7
references.pmid: 17205432