Impact of Acyclovir on Genital and Plasma HIV-1 RNA, Genital Herpes Simplex Virus Type 2 DNA, and Ulcer Healing among HIV-1–Infected 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‐1). Methods: Women from Ghana and the Central African Republic who had genital ulcers were enrolled in a randomized, double‐blind, placebo‐controlled trial of acyclovir plus antibacterials and were monitored for 28 days. Ulcer etiologies and detection of lesional HIV‐1 RNA were determined by polymerase chain reaction (PCR). Cervicovaginal HIV‐1 RNA and herpes simplex virus type 2 (HSV‐2) DNA and plasma HIV‐1 RNA were quantitated by real‐time PCR. Primary analyses included 118 HIV‐1–infected women with HSV‐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‐1 RNA (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.8–1.2) at day 7 of treatment, (2) the mean cervicovaginal HIV‐1 RNA load (−0.06 log<sub>10</sub> copies/mL; 95% CI, −0.4 to 0.3 log<sub>10</sub> copies/mL) at day 7 of treatment, or (3) the plasma HIV‐1 RNA load (+0.09 log<sub>10</sub> copies/mL; 95% CI, −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‐1 RNA (RR, 0.70; 95% CI, 0.4–1.2) or cervicovaginal HSV‐2 DNA (RR, 0.69; 95% CI, 0.4–1.3), had a lower quantity of HSV‐2 DNA (−0.99 log<sub>10</sub> copies/mL; 95% CI, −1.8 to −0.2 log<sub>10</sub> copies/mL), and were more likely to have a healed ulcer (RR, 1.26; 95% CI, 0.9–1.9). Conclusion: Episodic therapy for herpes reduced the quantity of cervicovaginal HSV‐2 DNA and slightly improved ulcer healing, but it did not decrease genital and plasma HIV‐1 RNA loads. [See also the conference presentation reporting on this study].
Citation
Mayaud, P.; Legoff, J.; Weiss, H.A.; Grésenguet, G.; Nzambi, K.; Bouhlal, H.; Frost, E.; Pépin, J.; Malkin, J.E.; Hayes, R.J.; Bélec, 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]