title: Effect of HSV-2 suppressive therapy on genital tract HIV-1 RNA shedding among women on HAART: a pilot randomized controlled trial.
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.
authors.affiliation: Division of General Internal Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Nijhawan
authors.forename: A K
authors.initials: AK
authors.lastname: Delong
authors.forename: S
authors.initials: S
authors.lastname: Chapman
authors.forename: A
authors.initials: A
authors.lastname: Rana
authors.forename: J
authors.initials: J
authors.lastname: Kurpewski
authors.forename: J
authors.initials: J
authors.lastname: Ingersoll
authors.forename: A M
authors.initials: AM
authors.lastname: Caliendo
authors.forename: S
authors.initials: S
authors.lastname: Cu-Uvin
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D000998:Antiviral Agents / Q000627:therapeutic use; D060085:Coinfection; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005836:Genitalia, Female / Q000821:virology*; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects*; D006558:Herpes Genitalis / Q000188:drug therapy*; D018258:Herpesvirus 2, Human; D006801:Humans; D008875:Middle Aged; D010865:Pilot Projects; D012367:RNA, Viral / Q000097:blood; D012044:Regression Analysis; D019562:Viral Load; D017201:Virus Shedding / Q000187:drug effects; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D012367:RNA, Viral; D000212:Acyclovir