In patients with high CD4 cell counts and uncomplicated disease, oral aciclovir may be considered if initiated within 24 h of onset of the varicella rash. Alternative oral agents

include famciclovir and valaciclovir though, there is limited data on their use in HIV-seropositive individuals despite extensive anecdotal experience. 6.2.6.2 Zoster. Treatment of zoster in HIV-seropositive patients should begin as soon as possible (preferably within 72 h of onset of the skin rash) and be continued for at least 7 days or until all lesions have dried and crusted. For localised dermatomal herpes zoster, oral aciclovir at a dose of 800 mg five times per day is recommended. Famciclovir and valaciclovir are alternative agents although data learn more to support their use has thus far only been available in meetings abstracts [28,29], but they may be preferred by some because of the more convenient dosing and their ability to

cause higher antiviral levels in the blood as discussed in other guidelines [25]. For severe cutaneous disease or disseminated herpes zoster infection with evidence of visceral involvement, including CNS disease, admission to hospital and treatment with intravenous aciclovir (10 mg/kg every 8 h) is recommended [30,31] and 10–14 days of treatment is usually required, based on the experience in PLX4032 mw HIV-seronegative immunocompromised individuals (category III recommendation). 6.2.6.3 Aciclovir resistance. Persistent disseminated VZV infection that fails to respond to intravenous or oral aciclovir has been described in patients with advanced HIV disease [13,14]. In vitro tests show that the virus isolated is deficient for thymidine kinase and therefore resistant to aciclovir. Famciclovir and valaciclovir are not active against VZV in this setting. Intravenous foscarnet is the agent of choice for aciclovir-resistant VZV infection [32,33]. 6.2.6.4 Adjunctive therapy. There have been old no studies of corticosteroids in the management of HIV-associated zoster and there

is currently no indication they should be used. Likewise there are no specific studies addressing the management of postherpetic neuralgia in HIV-seropositive individuals. In the absence of these the therapeutic approach should follow that of HIV-seropositive individuals as outlined in recent guidelines [25]. Post exposure prophylaxis following significant exposure of an HIV-seropositive patient to VZV, and the potential use of the VZV vaccine in HIV-seropositive patients, are discussed in [34]. The PubMed database was searched under the following headings: HIV or AIDS and herpes simplex virus or HSV or genital herpes or HSV encephalitis or HSV CNS disease. Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) are double-stranded DNA viruses of the Herpesviridae family. HSV infection most commonly causes genital or orolabial ulcerative disease. Genital HSV is the leading cause of genital ulcerative disease worldwide.