Acyclovir and Transmission of HIV-1 from Persons Infected with HIV-1 and HSV-2

• Published in: The New England journal of medicine Vol. 362; no. 5; pp. 427 - 439
• Main Authors: Celum, C, Wald, A, Lingappa, J.R, Magaret, A.S, Wang, R.S, Mugo, N, Mujugira, A, Baeten, J.M, Mullins, J.I, Hughes, J.P, Bukusi, E.A, Cohen, C.R, Katabira, E, Ronald, A, Kiarie, J, Farquhar, C, Stewart, G.J, Makhema, J, Essex, M, Were, E, Fife, K.H, de Bruyn, G, Gray, G.E, McIntyre, J.A, Manongi, R, Kapiga, S, Coetzee, D, Allen, S, Inambao, M, Kayitenkore, K, Karita, E, Kanweka, W, Delany, S, Rees, H, Vwalika, B, Stevens, W, Campbell, M.S, Thomas, K.K, Coombs, R.W, Morrow, R, Whittington, W.L.H, McElrath, M.J, Barnes, L, Ridzon, R, Corey, L
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 04-02-2010
• Subjects: Acyclovir - adverse effects; Acyclovir - therapeutic use; Adolescent; Adult; AIDS-Related Opportunistic Infections - drug therapy; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Biological and medical sciences; CD4 Lymphocyte Count; Disease transmission; Female; Follow-Up Studies; General aspects; Herpes Genitalis - complications; Herpes Genitalis - drug therapy; Herpesvirus 2, Human; HIV; HIV Infections - complications; HIV Infections - transmission; HIV-1 - genetics; HIV-1 - isolation & purification; Human immunodeficiency virus; Human viral diseases; Humans; Infections; Infectious diseases; Intention to Treat Analysis; Kaplan-Meier Estimate; Male; Medical sciences; Patient Compliance; Pharmacology. Drug treatments; Pregnancy; RNA, Viral - blood; Unsafe Sex - statistics & numerical data; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Young Adult; Immunopathology; Acyclic nucleoside; Purine nucleoside; HIV-1 virus; Herpesviridae; Alphaherpesvirinae; Transmission; Retroviridae; AIDS; Immune deficiency; Lentivirus; HIV-2 virus; Infection; Virus; Medicine; Viral disease; Aciclovir; Human herpesvirus 2; Nucleoside analog; Antiviral; Human immunodeficiency virus; DNA polymerase inhibitor
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa0904849

Suppressive therapy for herpes simplex virus 2 (HSV-2) has also been shown to reduce the levels of human immunodeficiency virus type 1 (HIV-1). However, in this placebo-controlled trial involving 3408 African couples who were discordant in serologic status for these two viruses, daily treatment with acyclovir did not reduce the frequency of HIV-1 transmission, despite a reduction in HIV-1 RNA levels and a 73% reduction in the occurrence of HSV-2–positive genital ulcers.
In African couples who were discordant in serologic status for HIV-1 and HSV-2, daily treatment with acyclovir did not reduce the frequency of HIV-1 transmission, despite a reduction in HIV-1 RNA levels and a 73% reduction in the occurrence of HSV-2–positive genital ulcers.
The seroprevalence of herpes simplex virus type 2 (HSV-2), the most common cause of genital ulcer disease worldwide, is 60 to 90% in populations with human immunodeficiency virus type 1 (HIV-1).
1
Clinical manifestations of HSV-2 range from unrecognized or mild genital symptoms in most persons with HIV-1 infection to severe genital ulcer disease in persons with advanced HIV-1 disease.
2
,
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Genital shedding of the herpes simplex virus occurs on up to 30% of days in persons infected with HIV-1, often when they have no symptoms or observable lesions.
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,
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Laboratory and epidemiologic studies suggest that HSV-2 may increase the infectiousness . . .