EACS2023: 1088 Genital ulceration resistent to various treatments M. Hartmann , K. Kälber University Heidelberg, Dermatology, Heidelberg, Germany Title Clinical case title: Genital ulceration resistent to various treatments Clinical case body Text: A 38-year-old man presented with a 4-year history of penile ulceration. Due to a confirmed Human Immunodeficiency Virus (HIV) infection, he received an antiretroviral therapy (BIC/TAF/FTC). Laboratory testing showed a consistently negative HIV viral load (reference range, <20) and an unchanged CD4 cell count of 645 per cubic millimeter (reference range, 476-1581). On physical examination, there was a weeping ulceration with whitish coatings (Fig. 1a). Swabs were highly positive for herpes simplex virus (HSV) type 2 (PCR) and negative for syphilis and chlamydia. Despite several months of systemic therapy with aciclovir and repeated intravenous administration of foscarnet the ulceration didn’t heal. Genotypic resistance testing revealed a deletion at site 271, indicating aciclovir resistance, which may explain resistance to therapy with foscarnet. A therapy trial with cidofovir gel (Natrosol based 1%) applied twice daily was performed. After a few weeks the ulceration had almost completely healed. Cidofovir, a nucleotide analogue, is approved for treating cytomegalovirus retinitis in patients with HIV infection, but exhibits significant nephrotoxicity when administered systemically. Topically, cidofovir gel is well tolerated and an option for refractory HSV ulcerations. General conditions 1. I confirm that I previewed this clinical case and that all information is correct. I accept that the content of this clinical case cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of this clinical case constitutes the consent to publication (e.g. conference website, programmes, other promotions, etc.).: Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the clinical case. The corresponding author is responsible for informing the other authors about the status of the clinical case.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with theprivacy policy to provide the services described.: Yes 1 1 1 860 19TH EUROPEAN AIDS CONFERENCE | WARSAW 2023
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