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Updated January 5, 2011

Case 2: Acyclovir-Resistant Herpes Simplex Virus Infection

Author: David H. Spach, MD

A 36-year-old HIV-infected man with a CD4 count of 4 cells/mm3 presents with a 2 week history of a lesion on his lip. He has a history of recurrent herpes simplex infection and has received multiple courses of oral acyclovir (Zovirax). He increased his acyclovir dose from 400 mg PO tid to 800 mg PO tid, but the lesion has expanded further (Figure 1). This lesion is now painful and culture of the lesion has grown herpes simplex virus type 1.

Which of the following would be the most effective therapy at this point for presumptive acyclovir-resistant herpes simplex virus infection?

A Acyclovir (Zovirax) 10 mg/kg IV q8h.
B Famciclovir (Famvir) 500 mg PO tid.
C Foscarnet (Foscavir) 40 mg/kg IV q8h.
D Valacyclovir (Valtrex) 1000 mg PO tid.

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    Figure 1. Facial lesion caused by acyclovir-resistant herpes simplex virus infection.

    Large, gradually expanding superficial ulcerated lesion on face that has not responded to high-dose acyclovir.

    Figure 1