Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2009 Feb 20;23(4):461-9.
doi: 10.1097/QAD.0b013e32831db217.

Impact of aciclovir on genital and plasma HIV-1 RNA in HSV-2/HIV-1 co-infected women: a randomized placebo-controlled trial in South Africa

Sinéad Delany  1 , Nonkululeko Mlaba, Tim Clayton, Godspower Akpomiemie, Alexio Capovilla, Jerome Legoff, Laurent Belec, Wendy Stevens, Helen Rees, Philippe Mayaud
Affiliations
Randomized Controlled Trial

Impact of aciclovir on genital and plasma HIV-1 RNA in HSV-2/HIV-1 co-infected women: a randomized placebo-controlled trial in South Africa

Sinéad Delany et al. AIDS. .

Abstract

Background: Several studies suggest that herpes simplex virus type 2 (HSV-2) may enhance HIV-1 transmission and disease progression.

Methods: We conducted a randomized, double-blind, placebo-controlled trial of aciclovir 400 mg twice daily for 3 months in 300 HSV-2/HIV-1 co-infected women not yet on highly active antiretroviral therapy (HAART). Participants were evaluated prerandomization and at monthly visits for 3 months. Primary outcomes were the detection and quantity of genital HIV-1 RNA at the month 3 (M3) visit. Analyses were also undertaken using data from all visits. The treatment effects on plasma HIV-1 RNA, CD4 cell count and genital HSV-2 DNA were also assessed.

Results: At M3 fewer women had detectable genital HIV in the aciclovir group compared to placebo, but this was not significant [61/132 (46%) vs. 71/137 (52%), risk ratio (RR) 0.89, 95% confidence interval (CI) 0.70-1.14; P = 0.36]. There was also little difference in quantity of HIV-1 RNA among shedders (+0.13 log10 copies/ml, 95% CI -0.14 to 0.39) at M3. However, aciclovir significantly decreased the frequency of HIV-1 shedding over all visits [adjusted odds ratio (OR) 0.57, 95% CI 0.36-0.89]. Significant reductions in M3 plasma HIV-1 RNA (-0.34 log10 copies/ml, 95% CI 0.15-0.54), genital HSV-2 DNA (8 vs. 20%, RR 0.37, 95% CI 0.19-0.73) and genital ulceration (8 vs. 18%, RR 0.43, 95% CI 0.22-0.84) were observed in the aciclovir group.

Conclusion: HSV-2 suppressive therapy, by reducing HIV-1 plasma viral load and altering the pattern of genital HIV-1 shedding, may contribute to the reduction in sexual transmission of HIV-1 and may delay the requirement for HAART initiation.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Enrolment and follow-up of participants during the trial
Figure 2
Figure 2. Impact of aciclovir on the frequency of detection of genital HIV-1 RNA (panel 2A) and HSV-2 DNA (panel 2B) over time
Note: dashed line represents point of randomisation
Figure 2
Figure 2. Impact of aciclovir on the frequency of detection of genital HIV-1 RNA (panel 2A) and HSV-2 DNA (panel 2B) over time
Note: dashed line represents point of randomisation
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Weiss H. Epidemiology of herpes simplex virus type 2 infection in the developing world. Herpes. 2004;11:24A–35A. - PubMed
    1. Malkin JE. Epidemiology of genital herpes simplex virus infection in developed countries. Herpes. 2004;11(Suppl 1):2A–23A. - PubMed
    1. Smith JS, Robinson NJ. Age-specific prevalence of infection with herpes simplex virus types 2 and 1: a global review. J Infect Dis. 2002;186(Suppl 1):S3–28. - PubMed
    1. Corey L, Wald A, Celum CL, Quinn TC. The Effects of Herpes Simplex Virus-2 on HIV-1 Acquisition and Transmission: A Review of Two Overlapping Epidemics. J Acquir Immune Defic Syndr. 2004;35:435–445. - PubMed
    1. LeGoff J, Weiss HA, Gresenguet G, Nzambi K, Frost E, Hayes RJ, et al. Cervicovaginal HIV-1 and herpes simplex virus type 2 shedding during genital ulcer disease episodes. AIDS. 2007;21:1569–1578. - PubMed

Publication types

MeSH terms