HIV/AIDS Treatment and Care : Clinical protocols for the European ...

7.2.3. Treatment
Table 18. treatment of varicella-zoster infection
Paediatric HiV/aidS treatment and care
Infection Antimicrobial agenta Dose Frequency Route Duration
Varicella Children with moderate or sever immune suppression, high fever or necrotic lesions
Acyclovir 10–20 mg/kg TID
(three times
daily)
Children with mild immune suppression and mild oral disease:
Acyclovir 20 mg/kg (max:
200 mg/dose)
IV 7 days after no
new lesions
QID PO 7 days after no
new lesions
Zoster Children with severe immune suppression, trigeminal nerve involvement or extensive multidermatomal
zoster IV
Aciclovir 10–20 mg/kg TID IV 7–10 days
Children with mild immune suppression and mild oral disease
Aciclovir
For patients not responding to acyclovir
20 mg/kg (max:
200 mg/dose)
QID PO 7–10 days
a
Foscarnet 40–60 mg/kg TID IV 7–10 days
a Valaciclovir is approved for use in adult and adolescents with zoster at a dose of 1 gram PO BID 7–10 days; data on dosing
in children is limited.
7.3. Herpes simplex virus (HSV)
7.3.1. Prophylaxis
HIV-infected children with severe oral recurrences (more than 3–6 severe episodes a year) or previous
disseminated disease may benefit from prophylaxis with oral acyclovir (82).
7.3.2. Diagnosis
Neonatal HSV can appear as disseminated multi-organ disease (occurring in approximately 25%
of neonates with HSV infection), localized disease of the CNS (approximately 35% of infected neonates)
or localized disease of the skin, eyes and mouth (approximately 40% of infected neonates)
(83). Vesicular rash is present in approximately 80% of children with localized skin, eye or mouth
disease, but only in approximately 60% of children with CNS or disseminated disease (84, 85).
Outside of the neonatal period, the most common appearance of HSV infection in children is orolabial
disease. Fever, irritability, tender submandibular lymphadenopathy and superficial, painful
ulcers in the gingival and oral mucosae and perioral area characterize primary HSV gingivostomatitis.
HIV-infected children who experience primary infection when they are immunocompromised
can have severe local lesions or, more rarely, disseminated HSV with visceral involvement and
generalized skin lesions with primary infection. Other sites of involvement among severely immunocompromised
HIV-infected children include the oesophagus, CNS and genitals and disseminated
disease in the liver, adrenals, lungs, kidneys, spleen and brain.
Among children with suspected HSV encephalitis, detection of HSV DNA by PCR is the diagnostic
test of choice (86). CSF cultures for HSV are usually negative. Definitive diagnosis of HSV
oesophagitis requires endoscopy with biopsy (histological evidence of multinucleated giant cells
with intranuclear viral inclusion) and culture.
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