HAART suppresses genital tract HIV shedding in HIV/HSV co-infected women

There is limited data describing the effect of chronic HSV suppression on genital tract (GT) HIV among women on HAART.

Preliminary data was shown from a group of 34 women with HIV-1 / HSV-2 co-infection. The women in this study were receiving HAART with plasma viral load <75 copies/mL stable for at least 3 months prior to entry, and were randomly assigned to receive acyclovir 800 mg twice daily (n=22) or no acyclovir (n=12). Paired plasma and GT viral loads and GT HSV DNA values were taken every 4 weeks.

The mean baseline age of the women was 46 years and CD4 count 504 cells/mm3. 39% of women were white, 36% black and 18% Latino. None had positive tests for gonorrhoea, chlamydia, syphilis or HSV shedding and one had a positive trichomonas test at baseline.

Over the first 3 study visits (n= 97), 5 women experienced an episode of asymptomatic HSV shedding, 1/22 (4.5%) in the acyclovir arm and 4/12 (33.3%) in the control arm (p=0.04, OR=0.10, CI 0.0-1.2). These were not associated with GT HIV shedding. 5 women had episodes of GT HIV shedding during 7 follow-up visits (4250-850,000 copies/mL); 3/22 in the acyclovir arm and 2/12 in the control arm (p=1.0, OR=0.8, CI 0.08 to 11.0).

The investigators found predictors of GT HIV were detectable plasma viral load (OR 12.8, CI 2.5 -66.4) and baseline GT shedding (OR 5.98, CI 0.96 -37.1). Risk factors for HSV shedding in the acyclovir arm and GT HIV shedding in both arms were poor adherence to acyclovir and HAART respectively.

They concluded that the results of this small study reinforce the importance of HAART in decreasing HIV sexual transmission.

Nijhawan A, Delong A, Chapman A et al. Highly Active Antiretroviral Therapy suppresses genital tract HIV shedding with or without chronic HSV suppression among HIV-1/HSV-2 co-infected women. 48th ICAAC, 25-28 October 2008. Washington. Abstract H-2328.