Impact of Acyclovir on Genital and Plasma HIV-1 RNA, Genital Herpes Simplex Virus Type 2 DNA, and Ulcer Healing among HIV-1鈥揑nfected African Women with Herpes Ulcers: A Randomized Placebo-Controlled Trial.
Abstract
Background: Little is known about the impact of episodic treatment of herpes on human immunodeficiency virus type 1 (HIV鈥�1). Methods: Women from Ghana and the Central African Republic who had genital ulcers were enrolled in a randomized, double鈥恇lind, placebo鈥恈ontrolled trial of acyclovir plus antibacterials and were monitored for 28 days. Ulcer etiologies and detection of lesional HIV鈥�1 RNA were determined by polymerase chain reaction (PCR). Cervicovaginal HIV鈥�1 RNA and herpes simplex virus type 2 (HSV鈥�2) DNA and plasma HIV鈥�1 RNA were quantitated by real鈥恡ime PCR. Primary analyses included 118 HIV鈥�1鈥搃nfected women with HSV鈥�2 ulcers (54 of whom were given acyclovir and 64 of whom were given placebo). Results: Acyclovir had little impact on (1) detection of cervicovaginal HIV鈥�1 RNA (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.8鈥�1.2) at day 7 of treatment, (2) the mean cervicovaginal HIV鈥�1 RNA load (鈭�0.06 log<sub>10</sub> copies/mL; 95% CI, 鈭�0.4 to 0.3 log<sub>10</sub> copies/mL) at day 7 of treatment, or (3) the plasma HIV鈥�1 RNA load (+0.09 log<sub>10</sub> copies/mL; 95% CI, 鈭�0.1 to 0.3 log<sub>10</sub> copies/mL) at day 14 of treatment. At day 7, women receiving acyclovir were less likely to have detectable lesional HIV鈥�1 RNA (RR, 0.70; 95% CI, 0.4鈥�1.2) or cervicovaginal HSV鈥�2 DNA (RR, 0.69; 95% CI, 0.4鈥�1.3), had a lower quantity of HSV鈥�2 DNA (鈭�0.99 log<sub>10</sub> copies/mL; 95% CI, 鈭�1.8 to 鈭�0.2 log<sub>10</sub> copies/mL), and were more likely to have a healed ulcer (RR, 1.26; 95% CI, 0.9鈥�1.9). Conclusion: Episodic therapy for herpes reduced the quantity of cervicovaginal HSV鈥�2 DNA and slightly improved ulcer healing, but it did not decrease genital and plasma HIV鈥�1 RNA loads. [See also the reporting on this study].
Citation
Mayaud, P.; Legoff, J.; Weiss, H.A.; Gr茅senguet, G.; Nzambi, K.; Bouhlal, H.; Frost, E.; P茅pin, J.; Malkin, J.E.; Hayes, R.J.; B茅lec, L.; Mabey, D.C.W.; ANRS 1212 Study Group. Impact of Acyclovir on Genital and Plasma HIV&#8208;1 RNA, Genital Herpes Simplex Virus Type 2 DNA, and Ulcer Healing among HIV&#8208;1&#8211;Infected African Women with Herpes Ulcers: A Randomized Placebo&#8208;Controlled Trial. Journal of Infectious Diseases (2009) 200 (2) 216-226. [DOI: 10.1086/599991]