Infection with herpes viruses can cause sores and, in some cases, ulcers in the mouths and genitals of people. These sores can usually be treated with the following drugs:
Unfortunately, cases of herpes that are resistant to these drugs are increasingly leaving doctors and their patients with few options. However, a group of doctors in New York recently reported the case of a person with AIDS who successfully recovered from drug-resistant herpes when he was treated with the immune booster Aldara (imiquimod).
The doctors provided details on a 34-year-old man whose CD4+ count was 200 cells and whose viral load was "undetectable." He had been taking highly active antiretroviral therapy (HAART) for about a year and had symptoms of herpes on his genitals for about five months. Doctors prescribed the following regimens one at a time to treat the herpes infection:
Because these drugs did not help, doctors then prescribed 5% Aldara cream, which the man applied to his lesions and then washed off eight hours later. He did this three times in one week and then stopped the drug.
After four days, the pain from the herpes infection cleared. After one week, the lesions healed. The man has remained free from herpes lesions for at least one month and did not report any side effects associated with Aldara.
Aldara is licensed in North America for the treatment of warts on the genitals and anus. This drug appears to work by stimulating CD8+ cells and other cells of the immune system in the skin to fight viral infections. The drug is currently being investigated for the treatment of certain types of skin cancer. It has also been used to treat another troublesome AIDS-related complication — mollusca lesions — caused by MCV (Mollusca contagiosum virus). Further research on Aldara, and possibly more effective immune boosters such as resiquimod, is underway.
Aldara is not for everyone. The drug can cause severe skin irritation, rash and itching, among other side effects. Doctors are not sure if the drug will work for people with HIV/AIDS who have very low CD4+ counts. The team of doctors in New York suggests that Aldara be tested in clinical trials to confirm its anti-herpes activity.
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2. Hengge UR and Stark R. Topical imiquimod to treat intraepidermal carcinoma. Archives of Dermatology 2001;137:709-711.
3. Strauss RM, Doyle EL, Mohsen AH and Green ST. Successful treatment of moluscum contagiosum with topical imiquimod in a severly immunocompromised HIV-positive patient. International Journal of STDs and AIDS 2001;12(4):264-266 [Medline].
4. Arany I, Tyring SK, Stanley MA, et al. Enhancement of the innate and cellular immune response in patients with genital warts treated with topical imiquimod cream 5%. Antiviral Research 1999;43:55-63.
5. Ahonen CL, Gibson SJ, Smith RM, et al. Dendritic cell maturation and subsequent enhanced T-cell stimulation induced with the novel synthetic immune response modifier R-848.Cellular Immunology 1999;187:62-72.
6. Bernstein DI, Harrison CJ, Tomai MA and Miller RL. Daily or weekly therapy with resiquimod (R-848) reduces genital recurrences in herpes simplex virus-infected guinea pigs during and after treatment. Journal of Infectious Diseases 2001;183:844-849.
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Copyright © 2001 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284 http://www.catie.ca.
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