There are three treatments available for the treatment of herpes:

• Acyclovir (Zovirax®): Acyclovir has been studied and used for several years as a treatment for oral and genital herpes. It has been studied specifically in people with HIV and herpes and has been shown to be safe and effective. Acyclovir is available in a topical cream, pills, and an intravenous formulation. Most experts agree that the cream is not very effective and that pills are best for mild to moderate flare-ups or long-term suppressive therapy. Intravenous acyclovir is used to treat serious flare-ups or outbreaks that effect internal organs. The oral dose used to treat flare-ups is 400mg taken either three or four times a day, usually for seven to ten days. The dose can be doubled if the herpes sores fail to respond. Taking 400mg of the drug three-times daily or 800mg of the drug twice a day for a prolonged period of time can help prevent flare-ups from recurring. However, this is usually recommended only for patients who have a history of frequent recurrences.

• Valacyclovir (Valtrex®): Valacyclovir is a “pro-drug” of acyclovir and has been approved specifically for the treatment of herpes in HIV-positive people. Unlike acyclovir, valacyclovir needs to be broken down by the body before its active ingredient—acyclovir—can begin controlling the disease. This allows for higher amounts of acyclovir to remain in the body, thus requiring a lower dose of the drug to be taken by mouth. For mild to moderate herpes flare-ups, valacyclovir only needs to be taken once a day by mouth (1,000mg every day). For episodic therapy, valacyclovir is taken for seven to ten days. However, the drug can be taken every day for a prolonged period of time using half the dose needed to treat flare-ups (500mg every day). Like acyclovir, valacyclovir rarely causes side effects.
• Famciclovir (Famvir®): Famciclovir is one of the newest drugs to treat and prevent herpes flare-ups. Famciclovir is actually the pill form of a topical cream called penciclovir (Denavir®). Usually, 500mg of the drug is taken by mouth for seven to ten days. A dose of 250mg every day, taken for a prolonged period of time, is considered to be a safe and effective preventative therapy for recurrent herpes flare-ups.

• In some cases, herpes flare-ups do not respond to acyclovir, valacyclovir, or famciclovir, probably due to the emergence of drug-resistant forms of HSV-1 and HSV-2. HIV-positive patients with suppressed immune systems—usually a T-cell count less that 100—who have been receiving long-term acyclovir for the treatment and prevention of recurrent herpes flare-ups have been known to develop drug-resistant herpes. Because acyclovir is similar to both valacyclovir and famciclovir, simply switching to these two drugs is not usually effective. aclepsa.com

  At the present time, foscarnet (Foscavir®) is the most common treatment for acyclovir-resistant herpes. The drug must be administered via an intravenous (IV) line, usually three times a day, often in a hospital or under the close supervision of an in-home nurse.