GENITAL HERPES-SIMPLEX INFECTIONS IN PATIENTS WITH THE ACQUIRED-IMMUNODEFICIENCY-SYNDROME

On August 14, 1987, the Centers for Disease Control revised the survei llance case definition for the acquired immunodeficiency syndrome (AID S) to include several indicator diseases. The addition of herpes simpl ex virus (HSV) infections to the definition reemphasized the increasin g frequency of severe HSV infections in patients also infected with th e human immunodeficiency virus (HIV). These infections in patients wit h AIDS are associated with considerable morbidity similar to reports o f HSV in other immunocompromised populations. Their spectrum can inclu de persistent or recurrent genital disease, severe visceral involvemen t, and disseminated infection. Patients with AIDS also are at increase d risk of drug toxicities when receiving treatment for HSV infections in addition to antiretroviral therapy. Acyclovir, a selective and spec ific inhibitor of HSV replication, has been the mainstay of safe and e ffective treatment for HSV for more than a decade. However, reports of acyclovir-resistant strains of HSV in patients with AIDS have been st eadily increasing since 1989. Although foscarnet has been successful i n treating acyclovir-resistant strains, foscarnet-resistant strains ha ve also been isolated. The search to find novel approaches for the tre atment and suppression of HSV in patients with AIDS has become an adde d challenge in the management of this devastating disease.