Associação de aciclovir oral e imiquimode no tratamento de herpes simples genital hipertrófico em paciente com sida: relato de dois casos

Abstract

Chronic herpes simplex can present as exuberant clinical lesions, especially in HIV patients. The most probable mechanism of formation of these lesions is the invasion of the epidermal CD4 T cells by the herpes simplex virus. Due to the therapeutic difficulties and the high rates of treatment failure amongst these patients, new drugs are currently being discussed on the literature. Studies based on the immunophatology of these lesions have suggested that imiquimod might work as an adjuvant therapy to the antiviral drugs. Here we present two cases of excellent response to treatment with topical imiquimod as an adjuvant drug to acyclovir.

A case of an atypical resistant granulomatous HSV-1 and HSV-2 ulceration in an AIDS patient treated with intralesional cidofovir

“…The documented atypical herpetic dermatological manifestations found within the literature are mostly hypertrophic and exophytic in nature. 4–8 Leeyaphan et al 4 performed a retrospective observational study on the clinical characteristics of hypertrophic herpes simplex genitalis and found that hypertrophic lesions were only observed in HIV-positive patients. Furthermore, these findings were independent of CD4 + count, which lead them to conclude that HIV infection itself may be the mechanism behind exophytic HSV.…”

“…Another proposed mechanism behind the formation of atypical hypertrophic herpetic lesions is HSV infiltration of epidermal CD4 and dendritic cells, resulting in a T-helper 2 response that activates tumour necrosis factor (TNF)-alpha and interleukin production. 5,10 This then signals fibroblast proliferation and collagen formation. 5,10 Many of these atypical lesions are also resistant to acyclovir.…”

“…5,10 This then signals fibroblast proliferation and collagen formation. 5,10 Many of these atypical lesions are also resistant to acyclovir. 4–8,10 Treatment with imiquimod cream has been shown to have good results in these resistant cases of exophytic HSV, most likely due to its ability to stimulate T-helper 1 response and interferon production.…”

“…5,10 Many of these atypical lesions are also resistant to acyclovir. 4–8,10 Treatment with imiquimod cream has been shown to have good results in these resistant cases of exophytic HSV, most likely due to its ability to stimulate T-helper 1 response and interferon production. 4,5,10 Due to an immunological induced response rather than direct anti-viral action, there is no chance for viral resistance against imiquimod.…”

Therapeutic opportunities to manage COVID-19/SARS-CoV-2 infection: Present and future

“…[ 95 ] The second group of prophylactic agents may constitute of factors that enhances the anti-viral host immune response such as Imiquimod (imidazoquinolinamines) that enhance the secretion of type 1 interferon response. [ 105 106 107 108 ] The potential prophylactic strategies to prevent SARS-CoV-2 infection is summarized in Fig. 3 and Table 1 .…”