Management of Genital Herpes in People Living with HIV

First‑Episode Treatment (Acute Infection)

Recurrent Episodes (Episodic Therapy)

Chronic Suppressive Therapy

Monitoring for Antiviral Resistance

Critical Pitfalls to Avoid

Considerations Based on Degree of Immunosuppression

Management of Genital Herpes in HIV Patients

Primary Indication: Suppression of Recurrent Genital Herpes

• The Centers for Disease Control and Prevention recommends valacyclovir 500 mg twice daily for chronic suppressive therapy in HIV-infected adults, as this regimen is effective in preventing or delaying recurrences of genital herpes 2
• HIV-infected patients commonly experience frequent and severe recurrences of genital herpes due to their compromised immune status, and valacyclovir is a recommended treatment option 3, 2, 4

Secondary Indication: Episodic Treatment and Alternative Uses

• For the treatment of HSV-1 infections (oral herpes), valacyclovir 1g twice daily for 7-10 days for first episodes and 500mg twice daily for 5 days for recurrent episodes can be considered 5
• The Centers for Disease Control and Prevention suggests that patients should continue safer sex practices, including condom use, even while on suppressive therapy to prevent transmission during asymptomatic shedding 3, 2

Important Safety Considerations and Clinical Advantages

• Valacyclovir does not eradicate latent HSV or prevent transmission during asymptomatic shedding, and patients should be aware of this limitation 5
• For acyclovir-resistant HSV, foscarnet is required as valacyclovir will also be ineffective, highlighting the need for alternative treatment options in severely immunocompromised patients 3, 2, 6