Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

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Herpes Simplex Virus

Last Updated: September 17, 2015; Last Reviewed: January 27, 2017

Recommendations for Treating Herpes Simplex Virus (HSV) Infections
Treating Orolabial Lesions (Duration: 5–10 days)
  • Valacyclovir 1 g PO BID (AIII), or
  • Famciclovir 500 mg PO BID (AIII), or
  • Acyclovir 400 mg PO TID (AIII)
Treating Initial or Recurrent Genital Lesions (Duration: 5–10 Days)
  • Valacyclovir 1 g PO BID (AI), or
  • Famciclovir 500 mg PO BID (AI), or
  • Acyclovir 400 mg PO TID (AI)
Treating Severe Mucocutaneous HSV Infections (AIII)
  • Initial therapy acyclovir 5 mg/kg IV q8h
  • After lesions begin to regress, change to oral therapy as above.
  • Continue treatment until lesions have completely healed.
Chronic Suppressive Therapy
 Indications:
  • For patients with severe recurrences (AI), or
  • Patients who want to minimize the frequency of recurrences (AI), or
  • To reduce the risk of GUD in patients with CD4 cell counts <250 cells/mm3 who are starting ART (BI)
Treatment:
  • Valacyclovir 500 mg PO BID (AI), or
  • Famciclovir 500 mg PO BID (AI), or
  • Acyclovir 400 mg PO BID (AI)
  • Evaluate ongoing need for suppressive therapy annually.
For Acyclovir-Resistant Mucocutaneous HSV infections
Preferred Therapy:
  • Foscarnet 80–120 mg/kg/day IV in 2–3 divided doses until clinical response (AI)
Alternative Therapy (Duration: 21–28 days or longer, based on clinical response) (CIII):
  • Topical trifluridine, or
  • Topical cidofovir 1% gel, or
  • Topical imiquimod 5% cream three times/week, or
  • IV cidofovir 5 mg/kg IV once weekly
Note:
  • Topical formulations of trifluridine and cidofovir are not commercially available
  • Extemporaneous compounding of topical products can be prepared using trifluridine ophthalmic solution and the IV formulation of cidofovir.

Key to Acronyms: BID = twice daily; GUD = genital ulcer disease; HSV = herpes simplex virus; IV = intraveneously; PO = orally; TID = three times daily

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