Cold Sore in Well-Controlled HIV — SCE Infectious Diseases MCQ

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EasyHIV MedicineCold Sore in Well-Controlled HIVSCE Infectious Diseases

A 35-year-old woman with HIV on ART (CD4 480, VL <50) develops a first episode of Herpes simplex labialis (cold sore). She is otherwise well. How should this be managed?

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Correct answer: C — Standard management as for immunocompetent patients — topical Aciclovir cream (if presenting within 72 hours of onset) or oral Aciclovir 200 mg five times daily for 5 days; no special HIV-specific modification needed at this CD4

In well-controlled HIV with CD4 >200, herpes simplex labialis is managed identically to immunocompetent patients. Topical Aciclovir cream (applied 5 times daily for 5 days) is appropriate for mild/early cold sores. Oral Aciclovir (200 mg 5 times daily for 5 days or Valaciclovir 500 mg BD for 5 days) is used for more extensive or recurrent episodes. IV Aciclovir is reserved for severe, disseminated, or complicated HSV in immunocompromised patients. This underscores the principle of normalised management in well-controlled HIV.

Reference: BHIVA 2022 – OI guidelines; NICE CKS 2024 – Cold sores