Effect of HSV-2 suppressive therapy on genital tract HIV-1 RNA shedding among women on HAART: A pilot randomized controlled trial

• Type of Material: Article
• Authors: A.E. Nijhawan, Beth Israel Deaconess Medical Center; A.K. Delong, Brown University; S. Chapman, Brown University; A. Rana, Brown University; J. Kurpewski, Brown University; Jessica Mae Ingersoll, Emory University; Angela Caliendo, Emory University; S. Cu-Uvin, Brown University
• Language: English
• Date: 2012-03-16
• Publisher: Hindawi Publishing Corporation
• Publication Version: Final Published Version
• Copyright Statement: © 2012 A. E. Nijhawan et al.
• License: Creative Commons Attribution 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1155/2012/868526
• Title of Journal or Parent Work: Infectious Diseases in Obstetrics and Gynecology
• ISSN: 1064-7449
• Volume: 2012
• Start Page: 868526
• End Page: 868526
• Grant/Funding Information: This paper was supported by T32DA013911 from the National Institute on Drug Abuse at the National Institutes of Health (Grant no. T32 DA013911) (AN, AR); Lifespan/Tufts/Brown University Center for AIDS Research NIH at the National Institutes of Health (Grant no. P30AI42853P30 AI42853) (AN, AD, AR, SCU); American Sexually Transmitted Diseases Association (AN); National Institute of Allergy and Infectious Diseases at the National Institutes of Health (Grant nos. R01 AI40350 and K24 AI066884) (SCU); the Emory Center for AIDS Research at the National Institutes of Health (Grant no. P30 AI050409) (AC, JI).
• Keywords: Viral Load; Herpesvirus 2, Human; Herpes Genitalis; Regression Analysis; Acyclovir; Virus Shedding; Humans; Pilot Projects; Antiviral Agents; Female; Young Adult; Antiretroviral Therapy, Highly Active; Adult; Coinfection; HIV-1; Middle Aged; RNA, Viral; Genitalia, Female; HIV Infections; DNA, Viral
• Research Categories: Health Sciences, General; Health Sciences, Pathology

Abstract

Background. The role of suppressive HSV therapy in women coinfected with HSV-2 and HIV-1 taking highly active antiretroviral therapy (HAART) is unclear. Methods. 60 women with HIV-1/HSV-2 coinfection on HAART with plasma HIV-1 viral load (PVL) ≤75 copies/mL were randomized to receive acyclovir (N = 30) or no acyclovir (N = 30). PVL, genital tract (GT) HIV-1, and GT HSV were measured every 4 weeks for one year. Results. Detection of GT HIV-1 was not significantly different in the two arms (OR 1.23, P = 0.67), although this pilot study was underpowered to detect this difference. When PVL was undetectable, the odds of detecting GT HIV were 0.4 times smaller in the acyclovir arm than in the control arm, though this was not statistically significant (P = 0.07). The odds of detecting GT HSV DNA in women receiving acyclovir were significantly lower than in women in the control group, OR 0.38, P < 0.05. Conclusions. Chronic suppressive therapy with acyclovir in HIV-1/HSV-2-positive women on HAART significantly reduces asymptomatic GT HSV shedding, though not GT HIV shedding or PVL. PVL was strongly associated with GT HIV shedding, reinforcing the importance of HAART in decreasing HIV sexual transmission.