On-line Learning Zone
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About the
On-line Learning Zone

This section is aimed particularly at busy physicians and other healthcare professionals.

Visitors will find slides and notes from keynote lectures covering a wide range of herpesvirus-related topics. They will also find a diagnostic atlas comprising clinical photographs of herpesvirus infections accompanied by diagnostic notes.

Visitors are welcome to both view and download every file included in this section.

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Diagnostic Atlas Back to contents
HSV in immunocompromised patients

Slide 6
Vulval ulceration in an immunosuppressed patient with HIV


If a patient presents with extremely severe vulval ulceration or has lesions that do not respond to antiviral therapy, then immediate investigation of the patient’s immune function should be commenced. In some cases this will be normal, but in others, as in slide 6, the severity of the genital herpes will identify the patient’s immunosuppression due to HIV infection. In a patient with HIV infection and severely recurrent mucocutaneous HSV infections, it is essential that the physician is aware of the extremely rare risk of development of HSV resistance to antiviral therapies. Usually, the resistant strain is deficient in thymidine kinase, rendering the virus resistant to treatment with nucleoside analogues such as aciclovir, valaciclovir or famciclovir. Treatment by a specialist familiar with these problems, using either cidofovir or foscarnet, is advisable. It is essential that any clinician looking after a patient with HIV infection has the facility to arrange HSV-resistance testing in patients with non-healing or atypical lesions. Lack of response to antiviral therapy may also be due to sub-optimal dosing regimens, poor absorption or poor compliance.
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Last Updated : 28/07/2005 13:44:32