HIV and herpes simplex virus infection
Infections caused by human herpes simplex virus 1 (HSV-1) and type 2 (HSV-2) are common in persons aged 14 to 49 years. In the United States HSV-1 has a prevalence of 47.8% and HSV-2 is 11.9%. Until recently, most cases of recurrent genital herpes were reported to be because of HSV-2. However, over the past decade, HSV-1 reportedly causes 70% of the infections in some populations. Especially in young adult women and men who are sexually active. According to statistics, 70% of persons with HIV and HSV-2 are seropositive, whereas 95% are either positive for HSV-1 or HSV-2 infection. Patients with HSV-2 infection are at a 2 to 3 times higher risk of developing HIV and in coinfected patients.
Reactivation of HSV-2 causes an increase in the levels of HIV RNA in the blood and genital secretions. Oralabial herpes is a common manifestation of HSV-1 infection. It is also referred to as cold sores or fever blisters. Classic manifestations of oral HSV-1 include lesions on the lips and oral mucosa. These lesions evolve from papule to vesicle, ulcer and crust. The illness generally spans from 5 days to 10 days with the lesions recurring 1 to 12 times every year. These are often also triggered by sunlight or physiological stress.
In this case a 41-year-old patient with a history of human immunodeficiency infection (HIV) presented with two visible ulcerations on the scalp. The lesions became progressively larger over a span of two months. Histopathological analysis of the lesion showed the presence of multinucleated giant cells. Doctors treated the patient with acyclovir and the lesions showed complete resolution.
Local symptoms of disease may often include pain and pruritus. In addition, regardless of the severity of disease, viral shedding on the surfaces can lead to transmission.
Source: NEJM
