RESUMEN
Anogenital herpes is one of the most prevalent sexually transmitted infections worldwide. It has several clinical manifestations, from cases of primary herpes infection to recurrent forms, among them chronic mucocutaneous herpes. This presentation is rare, characterized by a duration of more than four weeks, usually associated with immunosuppression and resistance to classic anti-herpetic treatment. The present study presents a series of ten cases of chronic mucocutaneous herpes with a discussion about its clinical, laboratory, and therapeutic aspects.
Asunto(s)
Herpes Genital , Herpes Simple , Enfermedades de Transmisión Sexual , Herpes Genital/tratamiento farmacológico , HumanosAsunto(s)
Síndrome de Inmunodeficiencia Adquirida , Herpes Genital , Herpes Simple , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Aciclovir/uso terapéutico , Antivirales/uso terapéutico , Foscarnet/uso terapéutico , Herpes Genital/tratamiento farmacológico , Herpes Simple/tratamiento farmacológico , Humanos , Imiquimod/uso terapéuticoRESUMEN
Vegetative chronic genital herpes is an atypical presentation of herpes simplex 2 that it is usually seen in patients coinfected with human immunodeficiency virus. Clinically, it is characterized by extensive ulcers that evolve to chronification and hypertrophic pseudotumor forms. Antiviral drugs are recommended for the treatment, and acyclovir is the most used one. Foscarnet is the treatment of choice to resistant cases, although treatment failure has been reported. We report a male patient, previously diagnosed with human immunodeficiency virus who developed vegetative chronic genital herpes resistant to acyclovir and successfully treated with imiquimod.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adyuvantes Inmunológicos/uso terapéutico , Herpes Genital/tratamiento farmacológico , Imiquimod/uso terapéutico , Adyuvantes Inmunológicos/administración & dosificación , Adulto , Enfermedad Crónica , Relación Dosis-Respuesta a Droga , Herpes Genital/diagnóstico , Humanos , Imiquimod/administración & dosificación , Masculino , Resultado del TratamientoRESUMEN
Abstract Vegetative chronic genital herpes is an atypical presentation of herpes simplex 2 that it is usually seen in patients coinfected with human immunodeficiency virus. Clinically, it is characterized by extensive ulcers that evolve to chronification and hypertrophic pseudotumor forms. Antiviral drugs are recommended for the treatment, and acyclovir is the most used one. Foscarnet is the treatment of choice to resistant cases, although treatment failure has been reported. We report a male patient, previously diagnosed with human immunodeficiency virus who developed vegetative chronic genital herpes resistant to acyclovir and successfully treated with imiquimod.
Asunto(s)
Humanos , Masculino , Adulto , Herpes Genital/tratamiento farmacológico , Adyuvantes Inmunológicos/uso terapéutico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Imiquimod/uso terapéutico , Herpes Genital/diagnóstico , Adyuvantes Inmunológicos/administración & dosificación , Enfermedad Crónica , Resultado del Tratamiento , Relación Dosis-Respuesta a Droga , Imiquimod/administración & dosificaciónAsunto(s)
Humanos , Masculino , Adolescente , Pene/patología , Herpes Genital/diagnóstico , Herpes Genital/tratamiento farmacológico , Enfermedades de Transmisión Sexual/diagnóstico , Aciclovir/uso terapéutico , Herpesvirus Humano 2/aislamiento & purificación , Herpesvirus Humano 1/aislamiento & purificación , Diagnóstico DiferencialAsunto(s)
Aminoquinolinas/uso terapéutico , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Herpes Genital/diagnóstico , Herpes Genital/tratamiento farmacológico , Adyuvantes Inmunológicos/farmacología , Adyuvantes Inmunológicos/uso terapéutico , Aminoquinolinas/farmacología , Infecciones por VIH/complicaciones , Herpes Genital/complicaciones , Humanos , Imiquimod , Masculino , Persona de Mediana Edad , Pene/efectos de los fármacos , Pene/patología , Resultado del TratamientoRESUMEN
Herpes simplex virus (HSV) infections are common and widespread; nevertheless, their outcome can be of unpredictable prognosis in neonates and in immunosuppressed patients. Anti-HSV therapy is effective, but the emergence of drug-resistant strains or the drug toxicity that hamper the treatment is of great concern. Vaccine has not yet shown relevant benefit; therefore, palliative prophylactic measures have been adopted to prevent diseases. This short review proposes to present concisely the history of HSV, its taxonomy, physical structure, and replication and to explore the pathogenesis of the infection, clinical manifestations, laboratory diagnosis, treatment, prophylaxis and epidemiology of the diseases.
Asunto(s)
Antivirales/uso terapéutico , Herpes Genital/tratamiento farmacológico , Herpes Simple/tratamiento farmacológico , Herpesvirus Humano 1/patogenicidad , Herpesvirus Humano 2/patogenicidad , Herpes Genital/diagnóstico , Herpes Genital/epidemiología , Herpes Genital/inmunología , Herpes Simple/diagnóstico , Herpes Simple/epidemiología , Herpes Simple/inmunología , Herpesvirus Humano 1/clasificación , Herpesvirus Humano 1/efectos de los fármacos , Herpesvirus Humano 1/crecimiento & desarrollo , Herpesvirus Humano 2/clasificación , Herpesvirus Humano 2/efectos de los fármacos , Herpesvirus Humano 2/crecimiento & desarrollo , Humanos , Huésped Inmunocomprometido , Recién Nacido , Replicación Viral/efectos de los fármacos , Replicación Viral/genéticaRESUMEN
Herpes simplex viruses can cause uncommon systemic complications as acute liver failure (ALT) or urinary tract dysfunctions. Diphenyl diselenide, (PhSe)2 , a classical studied organic selenium compound, has a novel antiviral action against HSV-2 infection and well-known antioxidant and anti-inflammatory properties. This study aimed to investigate if (PhSe)2 reduces oxidative stress and systemic toxicity caused by HSV-2 infection in mice. Adult BALB/c mice were pre-treated with (PhSe)2 (5 mg kg-1 /day, intragastric, i.g.) during 5 days; at day 6 mice were infected with HSV-2 (10 µl-105 PFU/mL-1 ) and post-treated with (PhSe)2 for more 5 days. At day 11, they were killed and samples of liver and kidney were obtained to determine: reactive species (RS); malondialdehyde (MDA), and non-protein thiols (NPSH) levels; the activities of antioxidant enzymes, superoxide dismutase (SOD), and catalase (CAT). The activities of adenosine deaminase (ADA), Na+ /K+ -ATPase (liver and kidney); alanine aminotransferase (ALT), aspartate aminotransferase (AST), and the levels of urea (plasma) were determined as markers of hepatic and renal toxicity. The results revealed that (PhSe)2 treatment was effective against the increase of renal and hepatic oxidative stress in infected mice and also normalized hepatic and renal ADA activity. It recovered the activity of Na+ /K+ - and was not effective against the increase in urea levels in infected mice. Different from (PhSe)2 , acyclovir (positive control), caused an increase in ADA activity and a decrease in hepatic CAT activity. Considering the interest of alternative therapies to treat HSV-2 infections and secondary complications, (PhSe)2 become a notable candidate. J. Cell. Biochem. 118: 1028-1037, 2017. © 2016 Wiley Periodicals, Inc.
Asunto(s)
Antioxidantes/administración & dosificación , Antivirales/administración & dosificación , Derivados del Benceno/administración & dosificación , Herpes Genital/tratamiento farmacológico , Riñón/efectos de los fármacos , Hígado/efectos de los fármacos , Compuestos de Organoselenio/administración & dosificación , Adenosina Desaminasa/metabolismo , Animales , Antioxidantes/efectos adversos , Antioxidantes/farmacología , Antivirales/efectos adversos , Antivirales/farmacología , Derivados del Benceno/efectos adversos , Derivados del Benceno/farmacología , Catalasa/metabolismo , Femenino , Regulación de la Expresión Génica/efectos de los fármacos , Herpes Genital/virología , Herpesvirus Humano 2/efectos de los fármacos , Herpesvirus Humano 2/patogenicidad , Riñón/metabolismo , Hígado/metabolismo , Masculino , Ratones , Ratones Endogámicos BALB C , Compuestos de Organoselenio/efectos adversos , Compuestos de Organoselenio/farmacología , Estrés Oxidativo/efectos de los fármacos , Superóxido Dismutasa/metabolismoRESUMEN
BACKGROUND: Herpes simplex virus type-2 (HSV-2) may heighten immune activation and increase human immunodeficiency virus 1 (HIV-1) replication, resulting in greater infectivity and faster HIV-1 disease progression. An 18-week randomized, placebo-controlled crossover trial of 500 mg valacyclovir twice daily in 20 antiretroviral-naive women coinfected with HSV-2 and HIV-1 was conducted and HSV-2 suppression was found to significantly reduce both HSV-2 and HIV-1 viral loads both systemically and the endocervical compartment. METHODS: To determine the effect of HSV-2 suppression on systemic and genital mucosal inflammation, plasma specimens, and endocervical swabs were collected weekly from volunteers in the trial and cryopreserved. Plasma was assessed for concentrations of 31 cytokines and chemokines; endocervical fluid was eluted from swabs and assayed for 14 cytokines and chemokines. RESULTS: Valacyclovir significantly reduced plasma CXCL10 but did not significantly alter other cytokine concentrations in either compartment. CONCLUSIONS: These data suggest genital tract inflammation in women persists despite HSV-2 suppression, supporting the lack of effect on transmission seen in large scale efficacy trials. Alternative therapies are needed to reduce persistent mucosal inflammation that may enhance transmission of HSV-2 and HIV-1.
Asunto(s)
Quimiocina CXCL10/metabolismo , Infecciones por VIH/tratamiento farmacológico , VIH-1/inmunología , Herpes Genital/tratamiento farmacológico , Herpesvirus Humano 2/inmunología , Infecciones del Sistema Genital/tratamiento farmacológico , Aciclovir/análogos & derivados , Aciclovir/uso terapéutico , Adulto , Antivirales/uso terapéutico , Coinfección , Estudios Cruzados , Citocinas/metabolismo , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/virología , VIH-1/genética , VIH-1/aislamiento & purificación , Herpes Genital/complicaciones , Herpes Genital/virología , Herpesvirus Humano 2/genética , Herpesvirus Humano 2/aislamiento & purificación , Humanos , Persona de Mediana Edad , Infecciones del Sistema Genital/complicaciones , Infecciones del Sistema Genital/virología , Valaciclovir , Valina/análogos & derivados , Valina/uso terapéutico , Carga Viral , Adulto JovenRESUMEN
Diphenyl diselenide, (PhSe)2 , is an organoselenium compound with pharmacological actions mostly related to antioxidant and anti-inflammatory properties. The study investigated its antiviral and virucidal actions against herpes simplex virus 2 (HSV-2) infection in vitro and in a vaginal infection model in mice. The plaque reduction assay indicated that (PhSe)2 showed virucidal and antiviral actions reducing infectivity in 70.8% and 47%, respectively. The antiviral action of (PhSe)2 against HSV-2 vaginal infection was performed by infecting mice (10(5) PFU/ml(-1) ) at day 6. The treatment with (PhSe)2 (5 mg/kg/day, intragastric [i.g.]) followed 5 days before and for more 5 days after infection. The extravaginal lesion score was evaluated from days 6 to 10. At day 11, animals were killed, and histological evaluation, determination of viral load, and TNF-α and IFN-γ levels were performed in supernatants of homogenized vaginal tissue. The levels of reactive species (RS), protein carbonyl, non-protein thiols (NPSH), nitrate/nitrite (NOx), and malondialdehyde (MDA), and the activities of myeloperoxidase (MPO), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and glutathione reductase (GR) were determined. (PhSe)2 reduced the histological damage, extravaginal lesion scores, the viral load of vaginal tissue, and the activity of MPO, but increased the levels of TNF-α, IFN-γ. (PhSe)2 attenuated the increase of RS, MDA, NOx levels and the activity of GR caused by infection. (PhSe)2 also attenuated the reduction of NPSH content and the inhibition of CAT, SOD, and GPx activities. The antiviral action of (PhSe)2 against HSV-2 infection was related to its immunomodulatory, antioxidant, and anti-inflammatory properties. J. Cell. Biochem. 117: 1638-1648, 2016. © 2015 Wiley Periodicals, Inc.
Asunto(s)
Antiinflamatorios no Esteroideos/farmacología , Antioxidantes/farmacología , Antivirales/farmacología , Derivados del Benceno/farmacología , Herpes Genital/tratamiento farmacológico , Herpesvirus Humano 2 , Factores Inmunológicos/farmacología , Compuestos de Organoselenio/farmacología , Animales , Relación Dosis-Respuesta a Droga , Evaluación Preclínica de Medicamentos , Femenino , Herpes Genital/sangre , RatonesRESUMEN
Infection with herpes simplex viruses is one of the most ancient diseases described to affect humans. Infection with these viruses produces vexing effects to the host, which frequently recur. Infection with herpes simplex viruses is lifelong, and currently there is no vaccine or drug to prevent or cure infection. Prevalence of herpes simplex virus 2 (HSV-2) infection varies significantly depending on the geographical region and nears 20% worldwide. Importantly, HSV-2 is the first cause of genital ulcers in the planet. HSV-2 affects approximately 500 million people around the globe and significantly increases the likelihood of acquiring the human immunodeficiency virus (HIV), as well as its shedding. Thus, controlling HSV-2 infection and spread is of public health concern. Here, we review the diseases produced by herpes simplex viruses, the factors that modulate HSV-2 infection, the relationship between HSV-2 and HIV and novel therapeutic and prophylactic microbicides/antivirals under development to prevent infection and pathological outcomes produced by this virus. We also review mutations associated with HSV-2 resistance to common antivirals.
Asunto(s)
Antiinfecciosos/uso terapéutico , Quimioprevención/métodos , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Herpes Genital/complicaciones , Herpes Genital/tratamiento farmacológico , Herpesvirus Humano 2/aislamiento & purificación , Antiinfecciosos/aislamiento & purificación , Descubrimiento de Drogas/tendencias , Herpes Genital/virología , HumanosRESUMEN
O Herpes Genital é uma Doença Sexualmente Trans- missível (DST), que acomete milhares de pessoas, sendo considerada um problema de saúde pública, no Brasil. A Abordagem Sindrômica é uma ferramenta importan- te para a realização do diagnóstico precoce e tratamen- to, sendo utilizada pelo enfermeiro, durante a Consulta de Enfermagem, na Atenção Primária à Saúde (APS). Os objetivos foram destacar a atuação do enfermeiro no diag- nóstico e no tratamento do Herpes Genital, enfatizar o uso da Abordagem Sindrômica e destacar a importância da Consulta de Enfermagem para a aplicação dessa Abor- dagem. Trata-se de uma pesquisa de revisão bibliográfica. Concluiu-se que interromper a cadeia de transmissão, as- sim como desenvolver estratégias de prevenção, tratamen- to e aconselhamento é essencial no acompanhamento do portador do Herpes Genital.
Genital herpes is a sexually transmitted disease (STD) that afflicts thousands of people, and is considered a public health problem in Brazil. The syndromic approach is an important tool for conducting early diagnosis and treatment, being used by the nurse during nursing consultation in Primary Health Care (PHC). The objectives were to highlight the nurse's role in the diagnosis and treatment of genital herpes, emphasize the use of the syndromic approach, and highlight the importance of nursing consultation for the application of this approach. This study is a literature review. It concludes that interrupting the chain of transmission, as well as developing strategies for prevention, treatment, and counseling is essential in monitoring the patient with genital herpes.
Asunto(s)
Herpes Genital , Enfermeros , Atención Primaria de Salud , Herpes Genital/diagnóstico , Herpes Genital/tratamiento farmacológico , Enfermedades de Transmisión SexualRESUMEN
For trials of user-dependent HIV prevention products, accurate adherence measurements are essential to interpret and compare results across trials. We used pill count data from two recent HIV prevention trials of herpes simplex virus type 2 (HSV-2) suppression, to show that estimates of adherence vary substantially depending on assumptions that are made in analysing pill count data. We associate calculated adherence with biological markers of anti-HSV-2 activity. In both trials, calculated adherence varied considerably, depending on the summary measure used, and the handling of intervals with apparent 'over-adherence' (fewer pills returned than expected), and unreturned pills. Intervals of apparent over-adherence were associated with reduced antiviral effects on biological markers of herpes reactivation, indicating these are likely to represent periods of non-adherence. Our results demonstrate the clear need for standardisation in reporting of adherence data that are based on pill counts.
Asunto(s)
Aciclovir/administración & dosificación , Antivirales/administración & dosificación , Infecciones por VIH/prevención & control , Herpes Genital/tratamiento farmacológico , Registros Médicos/normas , Cumplimiento de la Medicación/estadística & datos numéricos , Adulto , África/epidemiología , Recuento de Linfocito CD4 , Método Doble Ciego , Femenino , Infecciones por VIH/epidemiología , Herpes Genital/epidemiología , Humanos , Masculino , Perú/epidemiología , Investigación Cualitativa , Autoadministración , Estados Unidos/epidemiología , Carga ViralRESUMEN
Agaricus brasiliensis (syn. A. subrufescens), a basidiomycete fungus native to the Atlantic forest in Brazil, contains cell walls rich in glucomannan polysaccharides. The ß-(1 â 2)-gluco-ß-(1 â 3)-mannan was isolated from A. brasiliensis mycelium, chemically modified by sulfation, and named MI-S. MI-S has multiple mechanisms of action, including inhibition of herpes simplex virus (HSV) attachment, entry, and cell-to-cell spread (F. T. G. S. Cardozo, C. M. Camelini, A. Mascarello, M. J. Rossi, R. J. Nunes, C. R. Barardi, M. M. de Mendonça, and C. M. O. Simões, Antiviral Res. 92:108-114, 2011). The antiherpetic efficacy of MI-S was assessed in murine ocular, cutaneous, and genital infection models of HSV. Groups of 10 mice were infected with HSV-1 (strain KOS) or HSV-2 (strain 333). MI-S was given either topically or by oral gavage under various pre- and posttreatment regimens, and the severity of disease and viral titers in ocular and vaginal samples were determined. No toxicity was observed in the uninfected groups treated with MI-S. The topical and oral treatments with MI-S were not effective in reducing ocular disease. Topical application of MI-S on skin lesions was also not effective, but cutaneously infected mice treated orally with MI-S had significantly reduced disease scores (P < 0.05) after day 9, suggesting that healing was accelerated. Vaginal administration of MI-S 20 min before viral challenge reduced the mean disease scores on days 5 to 9 (P < 0.05), viral titers on day 1 (P < 0.05), and mortality (P < 0.0001) in comparison to the control groups (untreated and vehicle treated). These results show that MI-S may be useful as an oral agent to reduce the severity of HSV cutaneous and mucosal lesions and, more importantly, as a microbicide to block sexual transmission of HSV-2 genital infections.
Asunto(s)
Agaricus/química , Antivirales/uso terapéutico , Polisacáridos Fúngicos/farmacología , Herpes Simple/tratamiento farmacológico , Herpesvirus Humano 1/efectos de los fármacos , Herpesvirus Humano 2/efectos de los fármacos , Animales , Antivirales/farmacología , Chlorocebus aethiops , Femenino , Polisacáridos Fúngicos/química , Herpes Genital/tratamiento farmacológico , Herpes Genital/virología , Herpes Simple/virología , Humanos , Queratitis Herpética/tratamiento farmacológico , Queratitis Herpética/virología , Ratones , Ratones Endogámicos BALB C , Pruebas de Sensibilidad Microbiana/métodos , Sulfatos , Resultado del Tratamiento , Células VeroRESUMEN
Propolis has been highlighted for its antioxidant, anti-inflammatory and antiviral properties. The purpose of this study was to investigate if brown Brazilian hydroalcoholic propolis extract (HPE) protects against vaginal lesions caused by herpes simplex virus type 2 (HSV-2) in female BALB/c mice. The treatment was divided in 5 days of pre-treatment with HPE [50 mg · kg(-1), once a day, intragastric (i.g.)], HSV-2 infection [10 µl of a solution 1 × 10(2) plaque-forming unit (PFU · ml(-1) HSV-2), intravaginal inoculation at day 6] and post-treatment with HPE (50 mg · kg(-1)) for 5 days more. At day 11, the animals were killed, and the in vivo analysis (score of lesions) and ex vivo analysis [haematological and histological evaluation; superoxide dismutase (SOD), catalase (CAT) and myeloperoxidase (MPO) activities; reactive species (RS), tyrosine nitration levels, non-protein thiols (NPSH) and ascorbic acid (AA) levels] were carried out. HPE treatment reduced extravaginal lesions and the histological damage caused by HSV-2 infection in vaginal tissues of animals. HPE was able to decrease RS, tyrosine nitration, AA levels and MPO activity. Also, it protected against the inhibition of CAT activity in vaginal tissues of mice. HPE promoted protective effect on HSV-2 infected animals by acting on inflammatory and oxidative processes, and this effect probably is caused by its antioxidant and anti-inflammatory properties.
Asunto(s)
Antiinflamatorios/farmacología , Antioxidantes/farmacología , Antivirales/farmacología , Herpes Genital/tratamiento farmacológico , Herpesvirus Humano 2 , Própolis/farmacología , Vagina/efectos de los fármacos , Animales , Antiinflamatorios/uso terapéutico , Antioxidantes/uso terapéutico , Antivirales/uso terapéutico , Mezclas Complejas/farmacología , Mezclas Complejas/uso terapéutico , Femenino , Herpes Genital/metabolismo , Herpes Genital/patología , Ratones Endogámicos BALB C , Própolis/química , Vagina/patología , Vagina/virologíaRESUMEN
Chronic herpes simplex can present as exuberant clinical lesions, especially in HIV patients. The most probable mechanism of formation of these lesions is the invasion of the epidermal CD4 T cells by the herpes simplex virus. Due to the therapeutic difficulties and the high rates of treatment failure amongst these patients, new drugs are currently being discussed on the literature. Studies based on the immunophatology of these lesions have suggested that imiquimod might work as an adjuvant therapy to the antiviral drugs. Here we present two cases of excellent response to treatment with topical imiquimod as an adjuvant drug to acyclovir.
Asunto(s)
Aciclovir/uso terapéutico , Adyuvantes Inmunológicos/uso terapéutico , Aminoquinolinas/uso terapéutico , Antivirales/uso terapéutico , Infecciones por VIH/complicaciones , Herpes Genital/tratamiento farmacológico , Adulto , Quimioterapia Combinada/métodos , Herpes Genital/etiología , Humanos , Imiquimod , Masculino , Persona de Mediana EdadRESUMEN
A infecção pelo vírus herpes simples tipo 2 (HSV-2) é frequente em pacientes infetados pelo vírus de imunodeficiência adquirida (VIH). Nestes casos, o herpes genital pode ter uma apresentação clínica atípica. As variantes hipertróficas e vegetantes são pouco habituais. Os autores relatam um caso de herpes hipertrófico perianal em paciente infetada pelo VIH, com resposta insatisfatória ao aciclovir e valaciclovir, tratado eficazmente com imiquimod tópico. O herpes genital hipertrófico é, frequentemente, refratário aos tratamentos antivirais. Na nossa experiência, o imiquimod é um tratamento eficaz, seguro e bem tolerado que deverá ser considerado na abordagem terapêutica destes pacientes.
Herpes simplex virus type 2 (HSV-2) infections are frequent in HIV (human immunodeficiency virus) infected patients. In those cases, genital herpes may have an atypical clinical presentation. Hypertrophic and vegetating variants are unusual. The authors describe a case of hypertrophic perianal herpes in an HIV patient with unsatisfactory response to acyclovir and valacyclovir, successfully treated with imiquimod. Hypertrophic genital herpes cases are frequently refractory to antiviral treatments. In our experience, imiquimod is an efficient, safe and well tolerated treatment that should be considered in therapeutic approach of these patients.
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Aminoquinolinas/uso terapéutico , Antivirales/uso terapéutico , Infecciones por VIH , VIH-1 , Herpes Genital/tratamiento farmacológico , /aislamiento & purificación , Aciclovir/uso terapéutico , Canal Anal/virología , Infecciones por VIH/complicaciones , Herpes Genital/etiología , Herpes Genital/patologíaRESUMEN
Herpes simples crônico é doença capaz de gerar apresentações exuberantes, principalmente em pacientes com sida. O provável mecanismo da formação dessas lesões hiperplásicas consiste na invasão viral dos linfócitos T CD4 situados na epiderme. Diante das dificuldades terapêuticas e da grande taxa de insucesso do tratamento nesses pacientes, novas terapias têm sido citadas na literatura atualmente. O conhecimento da imunopatologia ratificou o mecanismo pelo qual o imiquimode poderia ser eficaz como terapia adjuvante aos antivirais. Relatamos aqui dois casos de pacientes tratados com aciclovir associado ao imiquimode tópico que obtiveram resposta clínica excepcional.
Chronic herpes simplex can present as exuberant clinical lesions, especially in HIV patients. The most probable mechanism of formation of these lesions is the invasion of the epidermal CD4 T cells by the herpes simplex virus. Due to the therapeutic difficulties and the high rates of treatment failure amongst these patients, new drugs are currently being discussed on the literature. Studies based on the immunophatology of these lesions have suggested that imiquimod might work as an adjuvant therapy to the antiviral drugs. Here we present two cases of excellent response to treatment with topical imiquimod as an adjuvant drug to acyclovir.