- Maintenance therapy: Discontinue when CD4 cell count is >100 cells/ mm3 for >6 months, 12 months of therapy have been completed, and the patient is asymptomatic for MAC. Restart when CD4 count is <100 cells/mm3.
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Herpes Simplex
RISK: The risk is outbreaks of HSV and transmission of HSV in patients with positive serology for HSV-2 or lesions due to HSV-2. (See pg __).
RECOMMENDATION:
- 1) Disclosure of HSV-2 (and HIV) serostatus
- 2) Abstinence from sex during outbreaks with active herpetic lesions
- 3) Prophylactic valacyclovir (1 gm/d) for the partner with HSV-2 does not appear to reduce risk of HIV acquisition (Lancet 2008;371:2109). There is possible benefit of anti-HSV prophylaxis to prevent HIV transmission in the host with HIV/HSV co-infection.
- 4) Use of condoms reduces risk of transmitting both HIV and HSV.
- 5) Acyclovir has established efficacy in preventing transmission of HSV- 2 and is indicated independent of HIV for the patient with multiple recurrences.
INDICATION:HIV-infected patient with HSV-2 co-infection (See pg ____).
Varicella virus (VZV)
Note:There are two live virus varicella vaccines - one to prevent chickenpox in immunologically-naive patients and the herpes zoster vaccine for patients with prior varicella infection who are at risk for shingles.
CHICKENPOX VACCINE:
- RISK: Patient with negative VZV serology: approximately 1-3% of the US population, and much less common in those born before 1980
- PRE-EXPOSURE VACCINE PROPHYLAXIS:CHICKENPOX VACCINE: CD4 > 200 cells/mm3 + patient risk defined by: 1) previously unvaccinated; 2) no history of varicella or zoster; 3) seronegative to VZV and 4) born after 1980. Note that serologic evidence of immunity is recommended for persons born before 1980 who are immunocompromised (MMWR; June 22, 2007:16)
Note:Routine serology for VZV in patients with HIV is recommended if above factors do not indicate prior infection.
- VACCINE: Primary varicella (Chickenpox) vaccine (Varivax) in 2 doses as 0.5 mL SQ 3 months apart should be considered for VZV susceptible persons with HIV and a CD4 count >200/mm3. However, it has not been studied in patients with HIV infection.
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