Australian Herpes Management Forum

Research Update: Reduction of HIV-1 RNA Levels with Therapy to Suppress Herpes Simplex Virus

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March 2007

What's known?

Herpes simplex virus type 2 (HSV-2) has been recognized as the most common cause of genital ulcers in the developed world and recent studies show that HSV-2 is a common cause of genital ulcers in the developing world

HIV replication is compartmentalized in anatomic sites of the body, and the interactions between HIV type 1 (HIV-1) and microbes occupying these anatomic sites influence the amount and strain of HIV-1 in these regions

Epidemiologic and biologic data support a strong association between herpes simplex virus type 2 (HSV-2) and infection with human immunodeficiency virus type 1 (HIV-1)

Symptomatic HSV-2 reactivation has been associated with transient increases in plasma HIV-1 RNA levels and acyclovir treatment with reduced plasma HIV-1 RNA levels

What’s New?

Authors conducted a double-blind, placebo-controlled trial of 500 mg of valaciclvoir twice daily for 3 months among women who were dually infected with HIV-1 and HSV-2 in Bobo-Dioulasso, Burkina Faso

Women who were at least 16 years of age, had serum antibodies to both HSV-2 and HIV-1, and were not eligible for HAART were enrolled in the study

Cervicovaginal lavage enriched by cervical swabbing was performed for the detection and quantitation of genital HIV-1 RNA and HSV-2 DNA

HIV-1 RNA and HSV-2 DNA were quantitated by real-time polymerase-chain-reaction assay

136 (68 in each group) were included in the analyses. The median CD4 cell count was 446 cells per cubic millimetre and the mean plasma HIV-1 RNA level was 4.44 log10 copies per millilitre

On the basis of the pill count, the average treatment compliance was 97.2% in the valaciclovir group and 96.7% in the placebo group

Valaciclovir therapy was found to be associated with a significant decrease in the frequency of genital HIV-1 RNA (odds ratio, 0.41; 95% confidence interval [CI], 0.21 to 0.80) and in the mean quantity of the virus (log10 copies per millilitre, –0.29; 95% CI, –0.44 to –0.15)

The mean quantity of plasma HIV-1 RNA among women in the valaciclovir group was significantly lower than in the placebo group (–0.53 log10 copy per millilitre; 95% CI, –0.72 to –0.35, adjusted for mean baseline-phase value; P<0.001). In addition, the treatment effect on plasma HIV-1 RNA increased with time (P<0.001), with an average reduction of 0.09 log10 copy per millilitre every 2 weeks

The authors concluded that HSV suppressive therapy significantly reduces genital and plasma HIV-1 RNA levels in dually infected women

Reference

Nicolas Nagot,  Abdoulaye Ouédraogo, Vincent Foulongne, Issouf Konaté, Helen A. Weiss, Laurence Vergne, Marie-Christine Defer, Didier Djagbaré, Anselme Sanon, Jean-Baptiste Andonaba, Pierre Becquart, Michel Segondy, Roselyne Vallo, Adrien Sawadogo, Philippe Van de Perre, Philippe Mayaud, for the ANRS 1285 Study Group. Reduction of HIV-1 RNA Levels with Therapy to Suppress Herpes Simplex Virus. NEJM 2007; 356: 790-799.

Link

The full text of this paper is available at http://content.nejm.org/cgi/content/full/356/8/790. The paper can be viewed in HTML, PDF or PowerPoint format.

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