Resistant Herpes Simplex Virus Infection and HIV: A Potential Diagnostic and Therapeutic Dilemma

Herpes simplex virus (HSV) is the most frequent cause of genital ulcer disease worldwide. It is also 1 of the leading infections among HIV-infected individuals. Though HSV-2 is the principal etiologic agent of genital HSV infections (GH), HSV-1 has increasingly become a more common cause of GH, particularly in those with concurrent HIV. The clinical presentation of HSV in HIV-infected patients is often atypical. Individuals with depressed CD4 T-cell lymphocyte counts frequently present with more severe and protracted GH. Extensive, ulcerated, and necrotic lesions may make for a confusing initial clinical diagnosis. Furthermore, treatment with routine anti-herpetic viral agents may result in failure to resolve infection. Motivated by our recent experience involving an AIDS patient with a difficult-to-diagnose genital HSV infection that proved unresponsive to standard treatment, we review the topic of HSV anti-viral medication resistance with particular attention to its association in the HIV/HSV co-infected patient.