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3</a>&#41; e a imuno&#8208;histoqu&#237;mica para HSV1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>2 n&#227;o diferenciam o parasitismo decorrente de HSV1 ou HSV2&#46; O diagn&#243;stico dos casos de HMCC deve ser realizado&#44; preferencialmente&#44; com bi&#243;psia de pele&#44; pois a amostra pode tamb&#233;m ser analisada pela hibridiza&#231;&#227;o <span class="elsevierStyleItalic">in situ</span> e rea&#231;&#227;o em cadeia da polimerase &#40;PCR&#41; em busca da identifica&#231;&#227;o viral&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3&#44;4&#44;8</span></a> Al&#233;m disso&#44; o exame descarta diagn&#243;sticos diferenciais de &#250;lceras genitais como s&#237;filis&#44; infec&#231;&#227;o por citomegalov&#237;rus&#44; cancro mole&#44; infec&#231;&#245;es f&#250;ngicas ou por protozo&#225;rios&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">O tratamento empregado em&#160;70&#37; dos casos foi com aciclovir&#44; seguido de valaciclovir em&#160;20&#37; e foscarnete em&#160;10&#37;&#46; Duas pacientes apresentavam forma hipertr&#243;fica verrucosa&#44; e a abordagem terap&#234;utica nesses casos foi conforme descrita por diversos autores&#44; com antiviral associado a terapia local &#40;ex&#233;rese cir&#250;rgica ou imiquimode t&#243;pico&#41;&#44; apresentando melhora significativa &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#44;3</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">O tratamento das formas cr&#244;nicas ulceradas recomenda o uso de aciclovir oral&#44; na dose di&#225;ria de&#160;1&#46;000&#160;mg&#44; inicialmente por uma a duas semanas&#46; Essa dose di&#225;ria pode ser mantida ou aumentada para&#160;4&#46;000&#160;mg&#44; e a medica&#231;&#227;o pode ser administrada por via intravenosa &#40;10&#160;mg&#47;kg&#44; 3<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#47;dia&#41; em casos de resist&#234;ncia ou para superar problemas de biodisponibilidade&#44; pelo mesmo per&#237;odo&#46; Na persist&#234;ncia de falha terap&#234;utica&#44; indica&#8208;se valaciclovir oral &#40;dose di&#225;ria de&#160;3&#46;000&#160;mg&#41; ou fanciclovir &#40;dose di&#225;ria de 550 a 1&#46;500&#160;mg&#41;&#44; de uma a duas semanas&#46; Se considerada popula&#231;&#227;o viral resistente&#44; cujo principal fator associado &#233; o uso prolongado dos antivirais&#44; &#233; sugerido o uso de antivirais com outros mecanismos de a&#231;&#227;o&#44; como foscarnet&#44; cidofovir e vidarabina&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;3&#44;4&#44;8</span></a> Al&#233;m dessa abordagem medicamentosa voltada ao combate direto do HSV&#44; &#233; fundamental reverter a imunossupress&#227;o do paciente&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">O herpes mucocut&#226;neo cr&#244;nico&#44; apesar de bem estabelecido na literatura&#44; &#233; raro e pouco conhecido&#46; A diversidade de apresenta&#231;&#245;es cl&#237;nicas e sua resist&#234;ncia terap&#234;utica refor&#231;am o desafio no manejo dessa doen&#231;a&#46; Assim&#44; conhecer os aspectos aqui detalhados auxilia os m&#233;dicos no diagn&#243;stico e na conduta&#44; otimizando a terap&#234;utica e diminuindo a morbidade dos pacientes&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Suporte financeiro</span><p id="par0040" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contribui&#231;&#227;o dos autores</span><p id="par0045" class="elsevierStylePara elsevierViewall">Karina Baruel de Camargo Votto Calbucci&#58; Elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obter&#44; analisar e interpretar os dados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">John Verrinder Veasey&#58; Concep&#231;&#227;o e planejamento do estudo&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual na conduta proped&#234;utica e&#47;ou terap&#234;utica dos casos estudados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obter&#44; analisar e interpretar os dados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflito de interesses</span><p id="par0055" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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    "fechaRecibido" => "2021-02-11"
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            0 => "Antivirais"
            1 => "Doen&#231;as dos genitais femininos"
            2 => "Doen&#231;as dos genitais masculinos"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O herpes anogenital &#233; uma das infec&#231;&#245;es sexualmente transmiss&#237;veis mais prevalentes no mundo&#46; Apresenta diversas manifesta&#231;&#245;es cl&#237;nicas&#44; desde quadros de primoinfec&#231;&#227;o herp&#233;tica a formas recidivantes&#44; dentre as quais o herpes mucocut&#226;neo cr&#244;nico&#46; Essa apresenta&#231;&#227;o &#233; rara&#44; caracterizada por dura&#231;&#227;o de mais de quatro semanas&#44; geralmente associada a quadros de imunossupress&#227;o e a resist&#234;ncia ao tratamento anti&#8208;herp&#233;tico cl&#225;ssico&#46; O presente estudo apresenta s&#233;rie de dez casos de herpes mucocut&#226;neo cr&#244;nico com discuss&#227;o sobre seus aspectos cl&#237;nicos&#44; laboratoriais e terap&#234;uticos&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Calbucci KBCV&#44; Veasey JV&#46; Chronic mucocutaneous anogenital herpes&#58; series of ten cases and literature review&#46; An Bras Dermatol&#46; 2022&#59;97&#58;362&#8211;5&#46;</p>"
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        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado na Cl&#237;nica de Dermatologia&#44; Santa Casa de Miseric&#243;rdia de S&#227;o Paulo&#44; SP&#44; Brasil&#46;</p>"
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          "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Herpes mucocut&#226;neo cr&#244;nico&#58; imagens cl&#237;nicas de tr&#234;s pacientes do sexo masculino inclu&#237;dos no estudo &#40;A&#44; Caso&#160;7&#59; B&#44; Caso&#160;6&#59; C&#44; Caso&#160;9&#41;&#46;</p>"
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          "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Herpes mucocut&#226;neo cr&#244;nico&#58; imagens cl&#237;nicas de tr&#234;s pacientes do sexo feminino apresentando les&#245;es genitais e gl&#250;tea &#40;A&#44; Caso&#160;3&#59; B&#44; Caso&#160;2&#59; C&#44; Caso&#160;4&#41;&#46;</p>"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Esfrega&#231;o de les&#245;es submetido a colora&#231;&#227;o por pan&#243;tico r&#225;pido evidenciando c&#233;lulas epiteliais multinucleadas&#44; o que sugere inclus&#227;o viral por herpes&#8208;v&#237;rus&#44; chamadas c&#233;lulas de Tzank &#40;400<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#41;&#46;</p>"
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Paciente com herpes mucocut&#226;neo cr&#244;nico hipertr&#243;fico tumoral&#46; &#40;A&#41;&#44; Pr&#233;&#8208;tratamento&#46; &#40;B&#41;&#44; No p&#243;s&#8208;operat&#243;rio imediato da remo&#231;&#227;o cir&#250;rgica da les&#227;o tumoral&#46; &#40;C&#41;&#44; Ap&#243;s&#160;quatro semanas da ex&#233;rese cir&#250;rgica&#44; com ferida operat&#243;ria em cicatriza&#231;&#227;o&#46; &#40;D&#41;&#44; Ap&#243;s&#160;10&#160;semanas do procedimento&#44; com les&#227;o cicatrizada&#46;</p>"
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          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">M&#44; masculino&#59; F&#44; feminino&#59; NR&#44; n&#227;o realizado&#59;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#44; positivo&#59; &#8208;&#44; negativo&#59; HIV&#44; v&#237;rus da imunodefici&#234;ncia humana&#59; VO&#44; via oral&#59; EV&#44; via endovenosa&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas dos pacientes</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comorbidades&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tempo de les&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Localiza&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tzank&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Bi&#243;psia &#40;IHQ&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antiviral&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Via &#40;VO&#47;EV&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dose di&#225;ria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tempo at&#233; cura&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes <span class="elsevierStyleItalic">mellitus</span>&#160;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Genital&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Aciclovir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">VO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;200 mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HIV &#40;CD4 430 cels&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 m&#234;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Genital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Valaciclovir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;000 mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 semanas &#40;&#43; cirurgia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HIV &#40;CD4 6 cels&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 m&#234;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Genital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aciclovir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;400 mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Candid&#237;ase mucocut&#226;nea cr&#244;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 m&#234;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gl&#250;teo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Valaciclovir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;000 mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Albinismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 m&#234;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Genital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aciclovir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;000 mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Etilismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 m&#234;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Genital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aciclovir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;200 mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HIV &#40;CD4 187 cels&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Genital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aciclovir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;000 mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abandono&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HIV &#40;CD4 128 cels&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aciclovir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;400 mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#211;bito&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HIV &#40;CD4 112 cels&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Genital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aciclovir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;000 mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abandono&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HIV &#40;CD4 51 cels&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Genital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Foscarnet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">EV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;280mg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 semanas&nbsp;\t\t\t\t\t\t\n
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        0 => array:2 [
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            0 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of resistant mucocutaneous herpes simplex infections in AIDS patients&#58; a clinical and virological challenge"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Barde"
                            1 => "V&#46; Piguet"
                            2 => "M&#46; Pech&#232;re"
                            3 => "I&#46; Masouye"
                            4 => "J&#46;H&#46; Saurat"
                            5 => "W&#46; Wunderli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1468-1293.2010.00896.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "HIV Med&#46;"
                        "fecha" => "2011"
                        "volumen" => "12"
                        "paginaInicial" => "367"
                        "paginaFinal" => "373"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21251181"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vegetative chronic genital herpes with satisfactory response to imiquimod"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;M&#46; Siqueira"
                            1 => "B&#46;B&#46; Gon&#231;alves"
                            2 => "J&#46;B&#46; Loss"
                            3 => "R&#46;R&#46; Estrella"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/abd1806-4841.20198014"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Bras Dermatol&#46;"
                        "fecha" => "2019"
                        "volumen" => "94"
                        "paginaInicial" => "221"
                        "paginaFinal" => "223"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31090830"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rational use of acyclovir in the treatment of mucocutaneous herpes simplex virus and varicella zoster virus infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46;R&#46; Beutner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Semin Dermatol&#46;"
                        "fecha" => "1992"
                        "volumen" => "11"
                        "paginaInicial" => "256"
                        "paginaFinal" => "260"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acyclovir for chronic mucocutaneous herpes simplex virus infection in immunosuppressed patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;E&#46; Straus"
                            1 => "H&#46;A&#46; Smith"
                            2 => "C&#46; Brickman"
                            3 => "P&#46; Miranda"
                            4 => "C&#46; McLaren"
                            5 => "R&#46;E&#46; Keeney"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7326/0003-4819-96-3-270"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med&#46;"
                        "fecha" => "1982"
                        "volumen" => "96"
                        "paginaInicial" => "270"
                        "paginaFinal" => "277"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7059087"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0065"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Herpes simplex virus infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;J&#46; Whitley"
                            1 => "B&#46; Roizman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(00)04638-9"
                      "Revista" => array:7 [
                        "tituloSerie" => "Lancet&#46;"
                        "fecha" => "2001"
                        "volumen" => "357"
                        "paginaInicial" => "1513"
                        "paginaFinal" => "1518"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11377626"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0070"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of mucocutaneous herpes simplex infections with acyclovir"
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                          "autores" => array:1 [
                            0 => "P&#46;A&#46; Krusinski"
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                      ]
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                    0 => array:2 [
                      "doi" => "10.1016/s0190-9622(88)70023-7"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "1988"
                        "volumen" => "18"
                        "paginaInicial" => "179"
                        "paginaFinal" => "181"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3339139"
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                            0 => "M&#46;J&#46; Groves"
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                      "Revista" => array:6 [
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                        "volumen" => "93"
                        "paginaInicial" => "928"
                        "paginaFinal" => "934"
                        "link" => array:1 [
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                          "autores" => array:3 [
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Journal Information
Vol. 97. Issue 3.
Pages 362-365 (1 May 2022)
Visits
18704
Vol. 97. Issue 3.
Pages 362-365 (1 May 2022)
Dermatologia Tropical/Infectoparasitária
Open Access
Herpes anogenital mucocutâneo crônico: série de dez casos e revisão da literatura
Visits
18704
Karina Baruel de Camargo Votto Calbucci
Corresponding author
kbc.votto@gmail.com

Autor para correspondência.
, John Verrinder Veasey
Clínica de Dermatologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
This item has received

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Tabela 1. Herpes mucocutâneo crônico: aspectos clínicos dos dez pacientes incluídos, métodos diagnósticos e resposta terapêutica
Resumo

O herpes anogenital é uma das infecções sexualmente transmissíveis mais prevalentes no mundo. Apresenta diversas manifestações clínicas, desde quadros de primoinfecção herpética a formas recidivantes, dentre as quais o herpes mucocutâneo crônico. Essa apresentação é rara, caracterizada por duração de mais de quatro semanas, geralmente associada a quadros de imunossupressão e a resistência ao tratamento anti‐herpético clássico. O presente estudo apresenta série de dez casos de herpes mucocutâneo crônico com discussão sobre seus aspectos clínicos, laboratoriais e terapêuticos.

Palavras‐chave:
Antivirais
Doenças dos genitais femininos
Doenças dos genitais masculinos
Herpes genital
Herpes simples
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O herpes mucocutâneo crônico (HMCC) é a infecção causada pelos herpes‐vírus (HSV) tipo 1 e 2, com duração de mais de quatro semanas, resistente ao tratamento anti‐herpético clássico.1

O HMMC apresenta manifestações clínicas atípicas, com necessidade de confirmação por métodos complementares citológicos, laboratoriais ou anatomopatológicos.1 Em geral, é caracterizado clinicamente por lesões ulceradas dolorosas, de crescimento progressivo, que ocasionalmente evoluem para formas verrucosas, vegetantes ou tumorais, principalmente na síndrome de reconstituição imune do vírus HIV.1,2 O tratamento é desafiador: o hospedeiro costuma apresentar imunossupressão pronunciada, dificultando a resposta de defesa eficaz contra o agente agressor e a cicatrização eficiente da lesão. Por outro lado, é cada vez mais descrita a resistência viral intrínseca aos medicamentos clássicos, como aciclovir e valaciclovir.3–6

Dez pacientes com diagnóstico clínico e laboratorial de HMCC foram incluídos em estudo retrospectivo em clínica de dermatologia de hospital terciário em São Paulo (Brasil) entre janeiro de 2013 e novembro de 2020. Os dados detalhados constam na tabela 1, e aspectos clínicos estão mostrados nas figuras 1 e 2. Ressaltamos que todos relataram antecedente de quadro herpético local, indicando que as formas apresentadas de HMCC seriam variantes do herpes recidivante, e não de primoinfecção.

Tabela 1.

Herpes mucocutâneo crônico: aspectos clínicos dos dez pacientes incluídos, métodos diagnósticos e resposta terapêutica

Características dos pacientesCaracterísticas das lesõesDiagnósticoTratamento
Caso  Idade  Sexo  Comorbidades  Tempo de lesão  Localização  Tzank  Biópsia (IHQ)  Antiviral  Via (VO/EV)  Dose diária  Tempo até cura 
15  Diabetes mellitus 1  3 meses  Genital  NR  NR  Aciclovir  VO  1.200 mg  4 semanas 
52  HIV (CD4 430 cels/mm31 mês  Genital  NR  +  Valaciclovir  VO  1.000 mg  10 semanas (+ cirurgia) 
51  HIV (CD4 6 cels/mm31 mês  Genital  +  NR  Aciclovir  EV  2.400 mg  4 semanas 
15  Candidíase mucocutânea crônica  1 mês  Glúteo  +  NR  Valaciclovir  VO  1.000 mg  6 semanas 
59  Albinismo  1 mês  Genital  +  NR  Aciclovir  VO  4.000 mg  8 semanas 
46  Etilismo  1 mês  Genital  +  NR  Aciclovir  VO  1.200 mg  6 semanas 
58  HIV (CD4 187 cels/mm318 meses  Genital  NR  +  Aciclovir  VO  4.000 mg  Abandono 
30  HIV (CD4 128 cels/mm33 meses  Anal  +  NR  Aciclovir  EV  2.400 mg  Óbito 
41  HIV (CD4 112 cels/mm39 meses  Genital  +  ‐  Aciclovir  VO  1.000 mg  Abandono 
10  30  HIV (CD4 51 cels/mm33 meses  Genital  NR  +  Foscarnet  EV  5.280mg  3 semanas 

M, masculino; F, feminino; NR, não realizado;+, positivo; ‐, negativo; HIV, vírus da imunodeficiência humana; VO, via oral; EV, via endovenosa.

Figura 1.

Herpes mucocutâneo crônico: imagens clínicas de três pacientes do sexo masculino incluídos no estudo (A, Caso 7; B, Caso 6; C, Caso 9).

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Figura 2.

Herpes mucocutâneo crônico: imagens clínicas de três pacientes do sexo feminino apresentando lesões genitais e glútea (A, Caso 3; B, Caso 2; C, Caso 4).

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Casos anogenitais por HSV‐2 têm até seis vezes mais episódios de recorrência que os atribuídos ao HSV‐1, além de se manifestarem em forma subclínica em 10 a 25% dos pacientes.7 O citodiagnóstico de Tzank (fig. 3) e a imuno‐histoquímica para HSV1+2 não diferenciam o parasitismo decorrente de HSV1 ou HSV2. O diagnóstico dos casos de HMCC deve ser realizado, preferencialmente, com biópsia de pele, pois a amostra pode também ser analisada pela hibridização in situ e reação em cadeia da polimerase (PCR) em busca da identificação viral.3,4,8 Além disso, o exame descarta diagnósticos diferenciais de úlceras genitais como sífilis, infecção por citomegalovírus, cancro mole, infecções fúngicas ou por protozoários.

Figura 3.

Esfregaço de lesões submetido a coloração por panótico rápido evidenciando células epiteliais multinucleadas, o que sugere inclusão viral por herpes‐vírus, chamadas células de Tzank (400×).

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O tratamento empregado em 70% dos casos foi com aciclovir, seguido de valaciclovir em 20% e foscarnete em 10%. Duas pacientes apresentavam forma hipertrófica verrucosa, e a abordagem terapêutica nesses casos foi conforme descrita por diversos autores, com antiviral associado a terapia local (exérese cirúrgica ou imiquimode tópico), apresentando melhora significativa (fig. 4).2,3

Figura 4.

Paciente com herpes mucocutâneo crônico hipertrófico tumoral. (A), Pré‐tratamento. (B), No pós‐operatório imediato da remoção cirúrgica da lesão tumoral. (C), Após quatro semanas da exérese cirúrgica, com ferida operatória em cicatrização. (D), Após 10 semanas do procedimento, com lesão cicatrizada.

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O tratamento das formas crônicas ulceradas recomenda o uso de aciclovir oral, na dose diária de 1.000 mg, inicialmente por uma a duas semanas. Essa dose diária pode ser mantida ou aumentada para 4.000 mg, e a medicação pode ser administrada por via intravenosa (10 mg/kg, 3×/dia) em casos de resistência ou para superar problemas de biodisponibilidade, pelo mesmo período. Na persistência de falha terapêutica, indica‐se valaciclovir oral (dose diária de 3.000 mg) ou fanciclovir (dose diária de 550 a 1.500 mg), de uma a duas semanas. Se considerada população viral resistente, cujo principal fator associado é o uso prolongado dos antivirais, é sugerido o uso de antivirais com outros mecanismos de ação, como foscarnet, cidofovir e vidarabina.1,3,4,8 Além dessa abordagem medicamentosa voltada ao combate direto do HSV, é fundamental reverter a imunossupressão do paciente.

O herpes mucocutâneo crônico, apesar de bem estabelecido na literatura, é raro e pouco conhecido. A diversidade de apresentações clínicas e sua resistência terapêutica reforçam o desafio no manejo dessa doença. Assim, conhecer os aspectos aqui detalhados auxilia os médicos no diagnóstico e na conduta, otimizando a terapêutica e diminuindo a morbidade dos pacientes.

Suporte financeiro

Nenhum.

Contribuição dos autores

Karina Baruel de Camargo Votto Calbucci: Elaboração e redação do manuscrito; obter, analisar e interpretar os dados; revisão crítica da literatura; revisão crítica do manuscrito; aprovação da versão final do manuscrito.

John Verrinder Veasey: Concepção e planejamento do estudo; participação efetiva na orientação da pesquisa; participação intelectual na conduta propedêutica e/ou terapêutica dos casos estudados; elaboração e redação do manuscrito; obter, analisar e interpretar os dados; revisão crítica da literatura; revisão crítica do manuscrito; aprovação da versão final do manuscrito.

Conflito de interesses

Nenhum.

Referências
[1]
C. Barde, V. Piguet, M. Pechère, I. Masouye, J.H. Saurat, W. Wunderli, et al.
Management of resistant mucocutaneous herpes simplex infections in AIDS patients: a clinical and virological challenge.
[2]
S.M. Siqueira, B.B. Gonçalves, J.B. Loss, R.R. Estrella.
Vegetative chronic genital herpes with satisfactory response to imiquimod.
An Bras Dermatol., 94 (2019), pp. 221-223
[3]
K.R. Beutner.
Rational use of acyclovir in the treatment of mucocutaneous herpes simplex virus and varicella zoster virus infections.
Semin Dermatol., 11 (1992), pp. 256-260
[4]
S.E. Straus, H.A. Smith, C. Brickman, P. Miranda, C. McLaren, R.E. Keeney.
Acyclovir for chronic mucocutaneous herpes simplex virus infection in immunosuppressed patients.
Ann Intern Med., 96 (1982), pp. 270-277
[5]
R.J. Whitley, B. Roizman.
Herpes simplex virus infections.
Lancet., 357 (2001), pp. 1513-1518
[6]
P.A. Krusinski.
Treatment of mucocutaneous herpes simplex infections with acyclovir.
J Am Acad Dermatol., 18 (1988), pp. 179-181
[7]
M.J. Groves.
Genital Herpes: A Review.
Am Fam Physician, 93 (2016), pp. 928-934
[8]
O. Wauters, E. Lebas, A.F. Nikkels.
Chronic mucocutaneous herpes simplex virus and varicella zoster virus infections.
J Am Acad Dermatol., 66 (2012), pp. e217-e227

Como citar este artigo: Calbucci KBCV, Veasey JV. Chronic mucocutaneous anogenital herpes: series of ten cases and literature review. An Bras Dermatol. 2022;97:362–5.

Trabalho realizado na Clínica de Dermatologia, Santa Casa de Misericórdia de São Paulo, SP, Brasil.

Copyright © 2022. Sociedade Brasileira de Dermatologia
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