Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

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.

Herpes Simplex Virus

Last Updated: June 27, 2018; Last Reviewed: June 27, 2018

Panel's Recommendations

I. Will condoms (compared with not using condoms) prevent herpes simplex virus (HSV) infection in sexually active adolescents and young adults with HIV?

  • Condoms should be used to prevent HSV infection (and other sexually transmitted diseases) in adolescents and young adults with HIV (strong; low).
  • The data regarding the level of protection provided by condoms are very limited for individuals with HIV in general, and for youth specifically.

II. Will adolescents and young adults with HIV who have recurrent, genital HSV infection benefit from suppressive anti-HSV antiviral therapy (compared with not using suppressive therapy)?

  • Adolescents and young adults with HIV who suffer severe, frequent, and/or troubling recurrent genital HSV infection will benefit from anti-HSV suppression therapy (strong; moderate).

III. Should children and adolescents with HIV who have severe primary or recurrent HSV (genital or orolabial) infection receive intravenous (IV) acyclovir (compared with receiving oral antiviral therapy)?

  • Children and youth with HIV who have severe mucocutaneous HSV infections should be treated with IV acyclovir. When improvement is noted, they can be switched to oral therapy until healing is complete (strong; moderate).

IV. Should children and adolescents with HIV be treated with oral acyclovir, valacyclovir, or famciclovir for non-severe primary episodes or recurrent episodes of orolabial or genital HSV (compared with no antiviral therapy)?

  • Oral anti-HSV drugs will shorten the duration and reduce the severity of non-severe HSV infections in children and adolescents with HIV. Oral valacyclovir and famciclovir have superior pharmacokinetic profiles compared with oral acyclovir (strong; moderate).

V. Is foscarnet the best choice for anti-HSV therapy for children and adolescents with HIV in whom therapy is failing because of acyclovir-resistant HSV?

  • Foscarnet is the therapy of choice for acyclovir-resistant HSV (strong, very low). Ideally, the viral isolate should be tested to determine the antiviral resistance pattern.
Rating System
Strength of Recommendation: 
Strong; Weak
Quality of Evidence: High; Moderate; Low; or Very Low

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