HIV This Week

Dunne EF, Whitehead S, Sternberg M, Thepamnuay S, Leelawiwat W, McNicholl JM, Sumanapun S, Tappero JW, Siriprapasiri T, Markowitz L.Suppressive Acyclovir Therapy Reduces HIV Cervicovaginal Shedding in HIV- and HSV-2-Infected Women, Chiang Rai, Thailand. J Acquir Immune Defic Syndr. 2008 Sep 1;49(1):77-83.

Herpes simplex virus type 2 infection is important in the HIV epidemic and may contribute to increased HIV transmission. Dunne and colleagues evaluated the effect of suppressive acyclovir therapy on cervicovaginal HIV-1 shedding. HIV-1- and herpes simplex virus type 2- coinfected women aged 18-49 years with CD4 counts >200 cells/muL 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. Sixty-seven women were enrolled; at baseline, median CD4 count was 366 cells/muL, 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). 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 effct of suppressive therapy on HIV transmission.

Editors’ note: This first randomized, controlled crossover trial, meaning that women co-infected with HIV and herpes simplex virus-2 served as their own controls, found that acyclovir significantly reduced genital HIV-1 shedding. These immunocompetent women were not taking any antiretroviral drugs. Furthermore, acyclovir, which is commonly available and inexpensive, also reduced blood plasma HIV. These findings hold out promise for the trials of herpes suppression to reduce HIV transmission.