HIV & Herps
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Having genital herpes can increase the risk of being infected with HIV, the virus that causes AIDS, and it can cause serious problems for people living with HIV (human immunodeficiency virus).
People who have genital herpes sores are more likely to be infected with HIV during intercourse. When you develop a sore, the immune system tries to heal it, so there are many immune cells concentrated in that spot. Those are the cells that HIV infects. If HIV in semen, vaginal fluid, or blood comes in contact with a herpes sore, the risk for infection is high.
Genital Herpes and HIV Treatment Issues
It's more difficult to treat genital herpes if you also have HIV. Higher doses of antiviral drugs are often needed to treat herpes in people with HIV. Also, many people with HIV have strains of the herpes virus that are resistant to treatment with the standard antiviral drugs.
If you take antiviral drugs for genital herpes and the treatment isn't working, your doctor can test the virus you have for resistance. If the virus is resistant, there are other possible treatment alternatives, including the drugs Foscarnet and cidofovir.
If you have HIV, ask your doctor if you should be tested for genital herpes. If you already know that you have herpes and HIV, discuss treatment options with your doctor.
Oral and genital herpes
There are two main types, HSV 1 and 2. HSV 2 is most commonly associated with genital herpes, but both viruses can cause either genital or oral herpes.
Oral herpes causes tingling or painful fluid-filled blisters on the edge of the lip where it meets the skin of the face (‘cold sores’). These can occasionally develop on the nostrils, on the gums or on the roof of the mouth.
Genital herpes involves painful, fluid-filled blisters in the genital or anal areas, sometimes accompanied by fever, headache, muscle ache and a general feeling of being unwell.
Transmission and prevention
The virus can be transmitted from person to person by contact with skin where HSV is present. The virus passes easily through mucous membranes in the mouth, genital areas and anus, so can be passed on by kissing and other sexual contact. It can be passed from one part of the body to another, by touching the blisters or the fluid from them and then touching another part of the body. This can lead to particular problems if the infection is transferred to the eyes.
It is especially easy to get herpes when blisters are present, but it can also be transmitted when sores are not present. People with HIV are more likely to ‘shed’ virus, especially if they have a low CD4 count.
It is possible to pass herpes infection on to a baby through vaginal delivery. It is recommended you have a caesarean section if you are pregnant and have an active outbreak of herpes at the time of delivery.
Avoid having sex (oral, anal or vaginal), if you have symptoms or feel them starting. Don’t share sex toys, or cover them with a condom or wash them between uses. Avoid kissing if you or your partner has a cold sore. Avoid touching any affected area; thorough hand-washing will reduce the risk of spreading the infection if you do touch it.
Using a condom for anal, vaginal and oral sex offers a degree of protection from infection with herpes, or from passing on the virus to somebody else.
However, protection isn’t complete as the skin around the genital area may also carry the infection.
Herpes and HIV infection
Having HSV makes sexual transmission of HIV more likely. People with HIV and herpes are more able to pass on HIV as having herpes increases HIV viral load; in addition, HIV is present in herpes blisters. The presence of a herpes virus can increase the level of genital ‘shedding’ of HIV (virus being present in genital secretions at infectious levels).
HIV-negative people who have herpes blisters are more vulnerable to HIV infection, as the blisters provide a break in the skin through which HIV can enter.
It is thought that herpes may act as a 'co-factor' in HIV disease progression, activating HIV and making it easier for HIV to infect certain cells.
HSV is easiest to detect when the infection is still active, so it is best to seek medical advice as soon as you develop symptoms. It can be diagnosed by examining the affected skin, and by taking a swab of the fluid from a blister. A blood test can detect the virus, but this isn’t routinely used. A routine sexual health check won’t look for herpes unless you let staff know you have symptoms or are concerned.
Many people will not have any symptoms at all. Others will have symptoms within a few days of infection.
An outbreak of herpes involves painful blisters or sores which affect the mouth or genitals. Herpes lesions often start as numbness, tingling or itching. This feeling indicates that the virus is travelling up a nerve to the skin. There it causes small bumps that rapidly develop into small inflamed and fluid-filled blisters. These burst and crust over, typically taking a week to heal in people with healthy immune systems.
In people who are not on HIV treatment and whose immune system is very weakened, the first attack of genital herpes can be severe and long-lasting and, in some cases, cause serious, systemic illness.
From time to time, flare-ups can occur. HSV 2 recurs more often than HSV 1. Often, attacks become milder and less frequent as time goes on, usually about two years. In people living with HIV, especially if they have a very low CD4 cell count (under 50), herpes attacks tend to be more frequent, more severe and last longer. Sometimes the lesions can become infected with other bacteria.
Some people find certain triggers will bring on an outbreak, such as being unwell, tired or stressed, drinking alcohol and smoking, or exposure to the sun or sunbeds.
There is no treatment that can eradicate infection with herpes viruses.
HIV treatment is an important element in reducing frequency of herpes reoccurrences, but has less of an effect on genital shedding.
There are antiviral treatments that can reduce the discomfort of an outbreak. These reduce the amount of viral replication while you are taking them. The most commonly used treatments are aciclovir, valaciclovir and famciclovir. Antiviral treatments for herpes infection work well in people with HIV when used to treat outbreaks. There is some evidence they work less well to suppress herpes virus shedding in people living with HIV.
The sooner you start treatment, the more effective it is likely to be. Although effective at preventing outbreaks of herpes, once an attack of genital herpes is established antivirals often provide little benefit. It is recommended people with HIV start antiviral treatment for HSV as soon as possible after an outbreak starts.
Antivirals are usually taken in tablet form, up to five times a day for seven to ten days to treat serious attacks of oral herpes and genital or anal herpes. In serious cases, aciclovir can be given intravenously.
Antivirals can be taken as ‘episodic’ treatment, each time you feel the symptoms of the start of an attack (usually tingling and numbness). For many people with HIV, the standard episodic treatment course (of five days) will work well. However, if you have a weakened immune system, you may need a longer course of antivirals. They can also be prescribed as ‘suppressive’ treatment, usually if you have more than six outbreaks a year. If this is the case for you, you may be on treatment for up to a year.
You can reduce the discomfort of an outbreak by taking painkillers or applying a topical anaesthetic, such as lidocaine, and bathing the affected area in salty water. Applying an ice pack or cold wet teabags, may help. Avoid tight clothing and drink plenty of fluids.HIV & Herps
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