Suppressive acyclovir therapy reduces HIV cervicovaginal shedding in HIV- and HSV-2-infected women, Chiang Rai, Thailand.
BACKGROUND
Herpes simplex virus type 2 infection is important in the HIV epidemic and may contribute to increased HIV transmission. We evaluated the effect of suppressive acyclovir therapy on cervicovaginal HIV-1 shedding.


METHODS
HIV-1- and herpes simplex virus type 2-coinfected women aged 18-49 years with CD4 counts >200 cells/microL were enrolled in a randomized crossover trial of suppressive acyclovir therapy (NCT00362596, http://www.clinicaltrials.gov). For each woman, monthly plasma and weekly cervicovaginal lavage specimens were collected; the mean of the monthly median cervicovaginal lavage HIV-1 viral load and plasma HIV-1 viral load was compared.


RESULTS
Sixty-seven women were enrolled; at baseline, median CD4 count was 366 cells/microL, and median HIV-1 plasma viral load was 4.6 log10 copies/mL. The mean cervicovaginal lavage HIV-1 viral load was 1.9 (SD 0.8) log10 copies/mL during the acyclovir month and 2.2 (SD 0.7) log10 copies/mL during the placebo month (P < 0.0001); the mean decrease in HIV was 0.3 log10 copies/mL. The mean plasma HIV viral load during the acyclovir month (3.78 log10 copies/mL) was reduced compared with the placebo month (4.26 log10 copies/mL, P < 0.001).


CONCLUSIONS
Acyclovir reduced HIV genital shedding and plasma viral load among HIV-1- and herpes simplex virus type 2-coinfected women. Further data from clinical trials will examine the effect of suppressive therapy on HIV transmission.
Dunne
Eileen F
EF
National Center for HIV, Viral Hepatitis and STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA. dde9@cdc.gov
Whitehead
Sara
S
Sternberg
Maya
M
Thepamnuay
Sukhon
S
Leelawiwat
Wanna
W
McNicholl
Janet M
JM
Sumanapun
Surin
S
Tappero
Jordan W
JW
Siriprapasiri
Taweesap
T
Markowitz
Lauri
L
D000212:Acyclovir / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D002584:Cervix Uteri / Q000821:virology; D018592:Cross-Over Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1 / Q000302:isolation & purification*; D006558:Herpes Genitalis / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D008875:Middle Aged; D010919:Placebos; D013785:Thailand; D014621:Vagina / Q000821:virology; D019562:Viral Load; D017201:Virus Shedding / Q000187:drug effects*
D000998:Antiviral Agents; D010919:Placebos; D000212:Acyclovir