Chronic vulvar herpetic ulcer in a woman living with HIV: A case report

Introduction: There is a strong relationship between infectivity with Human Immunodeficiency Virus (HIV) and Herpes Simplex Virus (HSV); however the process leading to chronic herpetic lesions in HIV is still under investigation. Case report: There is evidence that patients receiving highly active antiretroviral therapy (HAART) may be more prone to chronic ulcers than those not receiving therapy. We present a case of a 35-year-old HIV-infected African American woman with a chronic herpetic ulcer of over 2 years duration, and suggest that her antiretroviral therapy is enabling her immune system to mount an ongoing attack against the herpes virus resulting in a chronic non-healing ulcer. Conclusion: Immune reconstitution inflammatory syndrome (IRIS) should be considered when a patient on HIV therapy presents with a chronic herpetic lesion. Correspondence to: Jeffrey B Morris, College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA, Tel: 954-881-5661; E-mail: [email protected] Jose A Carugno, University of Miami Miller School of Medicine, Miami, FL, USA, Tel: 305-689-8010; Fax: 305-243-3634; E-mail: [email protected] Received: April 02, 2017; Accepted: April 26, 2017; Published: April 29, 2017 Figure 1. Chronic vulvar herpetic ulcer in HIV-infected patients on HAART. Morris JB (2017) Chronic vulvar herpetic ulcer in a woman living with HIV: A case report Glob Dermatol, 2017 doi: 10.15761/GOD.1000210 Volume 4(2): 2-2 HIV-infected patients showed that after controlling for the confounders of age, gender and CD4 counts, patients receiving HAART for less than 6 months had a higher incidence of active genital herpes than those not receiving therapy [5]. Because IRIS is the result of the restoration of an immune response against a causative agent, definitive treatment is the removal of the agent. Reports have demonstrated complete elimination of chronic herpetic ulcers following treatment with oral acyclovir [6,7]. IV foscarnet or IV valacyclovir are effective in situations where acyclovir had been unsuccessful at eliminating the ulcer [7]. Our patient responded well to PO acyclovir; Figure 2 is eight weeks after initiation of treatment. The patient was left on prophylactic dose without recurrence in over one year. Conclusion This is an original case report of interest to dermatologists, gynecologists, infectious disease and general physicians. In short, IRIS should be considered a possible cause of healing delay in patients on HAART with chronic vulvar herpetic lesions. Physicians should educate their patients who are on HAART about the possibility of a prolonged presentation of genital ulcers, and the importance of early identification and treatment of the causative organism.