Viruses that are commonly associated with HIV/AIDS include:
Herpes simplex virus
Varicella zoster virus
Human papilloma virus
Herpes simplex virus infection (HSV)
Classical presentation of primary HSV infection includes
Lymph node enlargement
Small painful vesicles
Painful ulcers on the mucosa and skin
Pain along gluteal and upper thigh muscles (Sacral radiculomyelitis) may occur with genital/rectal HSV
Lesions usually resolve within 10-21 days after primary infection. The HSV then becomes latent in trigeminal and sacral nuclei and may reactivate.
Clinical features common in those with HIV/AIDS include:
Persistent/erosive genital/peri-rectal ulcerations which are mainly associated with HSV-2
More recurrent herpetic lesions.
The diagnosis is usually based on clinical history and physical findings. Laboratory tests include serology, culture, immunoflorescence or immunoassay
For mild and moderate cases of HSV, give Acyclovir 400mg orally three times daily for 7 days and for severe and recurrent HSV give Acyclovir 800mg orally, five (5) times daily for 5 days.
Varicella-zoster virus (Herpes zoster or shingles)
Early symptoms include pain (often severe and radicular) and fever followed 2-4 days later by vesicular rash over involved dermatomes. Primary varicella-zoster virus (VZV) infection usually results in chicken pox. However primary VZV infection in immuno-compromised persons may be associated with the following;-
More numerous lesions
Disseminated disease associated with pneumonitis, hepatitis and hemorrhagic skin lesions.
CNS manifestations including encephalitis and cerebellar ataxia
Prolonged healing time
Herpes zoster in HIV infected individuals may be more severe, with more recurrences and may involve more dermatomes
Diagnosis of herpes zoster is usually based on findings of characteristic painful skin lesions at different stages of evolution (erythema, papule, vesicles, crusts).
Analgesics are indicated, but the pain may be refractory even to potent analgesics.
Acyclovir 800mg 5 times per day for 7days.
With disseminated VZV or ophthalmic nerve involvement give IV/Oral Acyclovir 10 mg/kg/day 8 hourly, for 7 days
Erythromycin or Cloxacillin 500mg three times daily for 7 days for bacterial super-infection.
Post-herpetic pain: give Paracetamol/Aspirin or Diclofenac, also Amitriptylin 25-50mg nocte
Use of steroids (prednisolone) in herpes zoster is not recommended in this set up