TreatmentUpdate 74 - Volume 8, No 10; December 1996
Sean Hosein

Infections with herpes viruses can cause painful sores. Treatment with the drug acyclovir usually provides relief by allowing the sores to heal as viral activity is shut down. Since PHAs immune system's may not always be able to contain the infection, daily use of acyclovir (Zovirax) may be necessary to stop the sores from re-appearing. Over the long term, the germ that causes herpes, HSV (herpes simplex virus), may become resistant to acyclovir so other treatments need to be considered. We report below the experience of one PHA living in Spain.

History

The man had a painful herpes sores around a fingernail and his genitals. He had used oral acyclovir (dose unavailable) several times to suppress the infection, but the lesions grew larger and eventually formed ulcers. During the course of his anti-herpes treatment he also developed TB and lost weight.

Treatment

* IV acyclovir

The doctors prescribed iv (intravenous) acyclovir 10 mg/kg of body weight 8 hours daily for 3 weeks. When this did not work technicians took samples from his ulcer for testing and confirmed HSV infection.

* IV foscarnet

The doctors next prescribed iv foscarnet "50 mg/kg 3 times a day", and there was a "partial" recovery. After this the PHA received a daily dose of foscarnet 90 mg/kg. The ulcer grew then stabilized when his dose of foscarnet was increased.

* Idoxuridine

Doctors used this 'primitive' anti-herpes drug, putting a 40% strength solution of it on the ulcer, which did not cause it to heal.

* Cimetidine (Tagamet )

The doctors prescribed tablets of cimetidine, but this did not have any beneficial effect.

Combination therapy

The next regimen was a combination of iv foscarnet and iv acyclovir and oral famciclovir (another anti-herpes drug related to acyclovir) which also did not cause the ulcer to heal.

A last attempt

A final attempt at treatment involved three weekly injections of interferon-alpha into muscle. He started at a dose of 3 million units three times weekly which was slowly increased to 9 million units per dose combined with iv foscarnet. Four weeks after the doctors started the interferon-alfa they stopped giving him the foscarnet. Eight weeks after his first injection of interferon his ulcer finally healed and doctors stopped giving him interferon. He had been losing weight during his episode of herpes and though he had recovered from TB he died a week after the ulcer healed, of complications linked to "wasting syndrome."

REFERENCES:

1. Borrego L, Castro I, Frances A, et al. Treatment of acyclovir-resistant perianal herpetic ulceration with intramuscular interferon alfa. Archives of Dermatology 1996;132:1157-1158.

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Copyright © 1996 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284  http://www.catie.ca