Important note: Information in this article was accurate in December 2005. The state of the art may have changed since the publication date.
Treatment Issues: Newsletter of Current Issues in HIV/AIDS - Volume 19, Number 12, December 2005
Simon Collins, HIV i-Base
In an important proof of concept study presented at the 12th Annual Retrovirus Conference, Nicolas Nagot and colleagues from London School of Hygiene and Tropical Medicine, investigated whether suppressive treatment for herpes simplex virus (HSV) associated with genital herpes could have an impact on HIV transmission.1
The study randomized 140 women who were coinfected with HIV and HSV and were not eligible for ARV treatment, to either 1 gram valacyclovir daily for three months or placebo. Patients were followed for three months prior to randomization and for the three months during the study. HIV RNA and HSV DNA shedding in genital fluids were measured from cervical swabbing every two weeks.
The mean CD4 count at baseline was 519 and 482 cells/mm3 in the valacyclovir and placebo groups respectively. Overall visit attendance was reported as 93% and treatment adherence as 97%.
The reduction in HIV-1 RNA genital shedding was significantly greater in the valacylovir group than in the placebo group. HIV-1 shedding was significantly less persistent in the treated group. HIV-1 plasma viral load was also reduced in the valacyclovir group, as was HSV DNA shedding. The proportion of women shedding HSV at least once was 18.6% in the valacyclovir arm and 54.3% in the placebo arm.
Comment:
A recent analysis by Freeman of studies in this area concluded that a person with genital herpes has an approximately threefold greater risk of acquiring HIV infection after sexual exposure.2
Genital ulcers provide a reduced physical barrier to HIV and increase activation of local CD4 and dendritic cells, which are susceptible to HIV infection. If the source partner is coinfected with HIV and HSV they may also have higher HIV virus levels in genital fluids and therefore be more infectious.
Previous studies have highlighted the protective effect of valacyclovir treatment on the transmission of HSV to non-infected partners3, and data in this study supporting reduced risk of HIV transmission is clearly important. A similar benefit may be likely using the less expensive off-patent acyclovir.
References
More treatment information is available at www.i-base.info.
|
Study Parameters |
|||
| Treated Group | Placebo Group | P-value | |
| HIV RNA shedding in genital fluids (log copies/mL) | 0.26 | +0.09 | 0.003 |
| Persistence of HIV RNA shedding (% of women) | |||
| At every study visit | 14.3% | 27.1% | |
| At over half of study visits | 32.9% | 14.3% | |
| At less than half of study visits | 32.9% | 14.3% | |
| Never shed | 25.7% | 14.3% | 0.007 |
| HIV RNA in blood (log copies/mL) | 0.39 | +0.12 | <0.001 |
| HSV DNA shedding in genital fluids (log copies/mL) | 0.22 | +0.18 | <0.001 |
| Women who shed HSV at least once (%) | 18.6% | 54.3% | <0.001 |
20051210
GM191205
Copyright © 2005 - Treatment Issues. Reproduced with permission. Treatment Issues is published twelve times yearly by GMHC, Inc. All rights reserved. Noncommercial reproduction is encouraged. Subscription lists are kept confidential. GMHC Treatment Issues, The Tisch Building, 119 West 24th Street, New York, NY 10011 fredg@gmhc.org http://www.gmhc.org
AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, Elton John AIDS Foundation, Bridgestone/Firestone Charitable Trust, Bristol-Myers Squibb Company, National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2005. This material is designed to support, not replace, the relationship that exists between you and your doctor.
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Copyright ©1980, 2005. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content.