Progressive hypertrophic genital herpes in an HIV-infected woman despite immune recovery on antiretroviral therapy.
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.
Yudin
Mark H
MH
Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, ON, Canada. yudinm@smh.toronto.on.ca
Kaul
Rupert
R
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
D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000998:Antiviral Agents; D017245:Foscarnet; D000077271:Imiquimod
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