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    usmlemate is offline Junior Member
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    HIV with Herpes Simplex Virus Infection

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    A 26-year-old HIV-infected man with a CD4 count of 14 cells/mm3 presents with a 5 week history of lesions on his ear (Figure 1 and Figure 2). He has not taken any medications for these lesions. For the past week, the lesions have become more painful. A diagnosis of herpes simplex virus infection is eventually made.

    Which of the following is TRUE regarding herpes simplex infections in HIV-infected persons?

    A. When performing a fluorescent antibody (FA) and culture for herpes simplex virus, scraping the base of the lesion will provide a higher yield than obtaining exudative fluid.

    B. The most appropriate therapy for this lesion would be valganciclovir (Valcyte) 900 mg PO bid x 4 weeks.

    C. The diagnosis of chronic (longer than 4 weeks) ulcerative herpes simplex is an AIDS-defining condition, regardless of CD4 cell count.

    D. Answers A and C are correct.

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    usmlemate is offline Junior Member
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    Re: HIV with Herpes Simplex Virus Infection

    Quote Originally Posted by usmlemate
    A 26-year-old HIV-infected man with a CD4 count of 14 cells/mm3 presents with a 5 week history of lesions on his ear (Figure 1 and Figure 2). He has not taken any medications for these lesions. For the past week, the lesions have become more painful. A diagnosis of herpes simplex virus infection is eventually made.

    Which of the following is TRUE regarding herpes simplex infections in HIV-infected persons?

    A. When performing a fluorescent antibody (FA) and culture for herpes simplex virus, scraping the base of the lesion will provide a higher yield than obtaining exudative fluid.

    B. The most appropriate therapy for this lesion would be valganciclovir (Valcyte) 900 mg PO bid x 4 weeks.

    C. The diagnosis of chronic (longer than 4 weeks) ulcerative herpes simplex is an AIDS-defining condition, regardless of CD4 cell count.

    D. Answers A and C are correct.
    The correct answer is D.

    Answer A one component of the correct answer. Because herpes simplex virus is an intracellular virus, the yield of either fluorescent antibody (FA) or culture is significantly greater if a substantial number of cells are obtained when collecting the specimen. Direct HSV antigen testing with either FA, EIA, or PCR can provide rapid results (within 24 hours). Culture for herpes simplex virus is very sensitive and virus will typically grow in 1-4 days.

    Answer C another component of the correct answer. The Centers for Disease Control's case definition for AIDS (Category C) includes herpes simplex virus chronic ulcer(s) greater than 1 month's duration, regardless of the patient's CD4 cell count.

    Answer B is wrong. Among HIV-infected persons with episodic recurrent mucocutaneous herpes simplex infection, standard therapy would consist of oral therapy with either acyclovir (Zovirax) 400 mg bid, valacyclovir (Valtrex) 1000 mg bid, or famciclovir (Famvir) 250 mg bid. Valganciclovir (Valcyte) is an antiviral compound with excellent activity against cytomegalovirus, but it would not be appropriate to use as a first-line treatment against herpes simplex infections.

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