Current clinical issues in the management of herpes simplex virus infections in patients with HIV

Background: A recent study done in Baltimore showed HSV-2 seroprevalence of 81% among 64 HIV-positive homosexual or bisexual men. Objective: Our purpose was to examine HSV-2 as a risk factor for acquiring HIV infection, as well as to explore the possibility that acyclovir, an agent that inhibits the replication or infectivity in herpesviruses, might have a survival benefit to patients with HIV infection. Methods: Studies were undertaken among HIV-positive patients to see if concomitant treatments including acyclovir offered a survival benefit. Results: A Multicenter AIDS Cohort Study held at four university-affiliated clinics and two landmark analyses demonstrated that acyclovir offered a significant survival advantage for HIV-positive patients. Another study had less conclusive results. Conclusion: Enough evidence of a survival benefit in HIV-positive patients on long-term acyclovir therapy warrants consideration of long-term prophylactic therapy with suppressive doses of acyclovir as routine intervention for HIV-positive patients.