Background: Herpes simplex virus type 2 infection is important in the HIVepidemic 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/µL 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/µL, 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 log10copies/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.  

Journal of Acquired Immune Deficiency Syndromes ปี 2551, September ปีที่: 49 ฉบับที่ 1 หน้า 77-83

HIV-1, HIV transmission, HSV-2, Suppressive acyclovir