Question 5 - Oral Manifestations Question Bank

HIV Clinical Care Question Bank

Oral ManifestationsQuestion 5/10

A 30-year-old man with HIV and a CD4 count of 124 cells/mm³ presents for evaluation of a painful sore on his lower lip (Figure 1). A diagnosis of orolabial herpes simplex virus (HSV) is suspected since he has a history of orolabial herpes outbreaks in the past.

Which one of the following is TRUE regarding HSV-associated orolabial infections in persons with HIV?

HSV type 1 (HSV-1) is always the cause of HSV-associated oral lesions

The best method of diagnosis is type-specific HSV serology

A single dose of valacyclovir is recommended for episodic treatment of outbreaks

A herpes PCR test is the most sensitive test for diagnosis

Figure 1. Oral Ulcer on Lower Lip.

Source: photograph from David H. Spach, MD

Figure 2. Episodic and Suppressive Therapy for Orolabial HSV in Persons with HIV Infection.

Source: Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Non-CMV herpes: herpes simplex virus. May 7, 2013;1-416.

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Question Last Updated
January 28th, 2025

Table 1. **Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV**

Recommendations for Treating Orolabial Herpes Simplex Virus (HSV) Infections
Treating Orolabial Lesions (Duration: 5–10 Days) Valacyclovir 1 g PO twice daily (AIII), or Famciclovir 500 mg PO twice daily (AIII), or Acyclovir 400 mg PO three times daily (AIII)
Treating Severe Mucocutaneous HSV Infections (AIII) Initial therapy acyclovir 5 mg/kg IV every 8 hours After lesions begin to regress, change to oral therapy as above. Continue treatment until lesions have completely healed.
Chronic Suppressive Therapy Indications: For patients with severe recurrences (AI), including pregnant women, or Patients who want to minimize the frequency of recurrences (AI), or To reduce the risk of genital ulcer disease in patients with CD4 cell counts <250 cells/mm³ who are starting antiretroviral therapy (BI) Treatment: Valacyclovir 500 mg PO twice daily (AI), or Famciclovir 500 mg PO twice daily (AI), or Acyclovir 400 mg PO twice daily (AI) Evaluate ongoing need for suppressive therapy annually
Rating of Recommendations: A = Strong; B = Moderate; C = Optional Rating of Evidence: I = Data from randomized controlled trials; II = Data from well-designed nonrandomized trials, observational cohort studies with long-term clinical outcomes, relative bioavailability/bioequivalence studies, or regimen comparisons from randomized switch studies; III = Expert opinion

Source:

Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. National Institutes of Health, HIV Medicine Association, and Infectious Diseases Society of America. Herpes simplex virus. Last updated: July 14, 2025. [HIV.gov]

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