title: Meta-analysis of randomized trials on the association of prophylactic acyclovir and HIV-1 viral load in individuals coinfected with herpes simplex virus-2.
abstract: OBJECTIVE
  To summarize the randomized evidence regarding the association between acyclovir use and HIV-1 replication as measured by plasma HIV-1 RNA viral load among individuals coinfected with herpes simplex virus (HSV)-2.
  
  
  METHODS
  Meta-analysis of seven randomized trials conducted between 2000 and 2009. Inclusion criteria composed of acyclovir or valacyclovir use as prophylaxis among individuals coinfected with HIV-1 and HSV-2 who were ineligible for highly active antiretroviral therapy. HIV-1 viral load was the outcome.
  
  
  METHODS
  Random-effects summarization was used to combine treatment effect estimates. Stratified and meta-regression analyses were used to compare estimated treatment effects by characteristics of trials and participants.
  
  
  RESULTS
  The summary treatment effect estimate was -0.33 (95% confidence interval: -0.56, -0.10, 95% population effects interval: -0.74, 0.08) log(10) copies, an approximate halving of plasma viral load. However, there was marked heterogeneity (P < 0.001). Older median age, valacyclovir, higher compliance, earlier publication, and shorter study length were associated with a larger decrease in viral load as compared with their counterparts.
  
  
  CONCLUSIONS
  Current evidence suggests a range of favorable effects of acyclovir on plasma HIV-1 viral load among persons coinfected with HSV-2.
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Ludema
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.forename: Charles
authors.initials: C
authors.lastname: Poole
authors.forename: Haitao
authors.initials: H
authors.lastname: Chu
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use*; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000276:immunology*; D006558:Herpes Genitalis / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D018258:Herpesvirus 2, Human / Q000302:isolation & purification*; D006801:Humans; D012367:RNA, Viral; D016032:Randomized Controlled Trials as Topic; D019562:Viral Load
chemical_list: D012367:RNA, Viral; D000212:Acyclovir