{"id":3326,"date":"2006-05-12T09:36:03","date_gmt":"2006-05-12T08:36:03","guid":{"rendered":"http:\/\/moomango.co.uk\/htb\/?p=3326"},"modified":"2013-12-06T18:36:39","modified_gmt":"2013-12-06T18:36:39","slug":"effect-of-hsv-2-treatment-on-hiv-1-genital-shedding-and-plasma-viral-load","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/3326","title":{"rendered":"Effect of HSV-2 treatment on HIV-1 genital shedding and plasma viral load"},"content":{"rendered":"<p><strong>Polly Clayden, HIV i-Base<\/strong><\/p>\n<p><strong>Previous epidemiological data have suggested that herpes simplex virus 2 (HSV-2) infection can increase HIV-1 genital shedding, and in turn increase HIV-1 transmissibility among coinfected people. To date this causal relationship has never been demonstrated.<\/strong><\/p>\n<p>In an oral late breaker Nicolas Nagot presented findings from a proof of concept, randomised controlled trial of valacyclovir treatment (1000 mg daily vs. placebo for 3 months) among HIV-1\/HSV-2 co-infected women not eligible for HAART in Burkina Faso.<\/p>\n<p>The investigators evaluated the effect on HIV-1 genital shedding, HSV-2 genital shedding and HIV-1 plasma viral load.\u00a0 Study participants were followed bi-weekly for 3 months before and 3 months after randomisation for a total of 12 visits.<\/p>\n<p>A cervicovaginal lavage enriched by cervical swabbing was collected for HSV-2 DNA and HIV-1 RNA quantitation by real time PCR. Women who became pregnant during the trial (n=11) were censored in an intent to treat analyses censored. For each woman, the mean quantity of shedding (log copies\/mL) between the treatment and the baseline phases were compared. The mean of these differences was then compared between the two trial arms.<\/p>\n<p>140 women (70 in each arm) were randomised to receive valacyclovir or placebo. Mean CD4 counts were 519 and 482 cells\/mm<sup>3<\/sup> in the valacyclovir and placebo arms respectively.<\/p>\n<p>The investigators reported good attendance and adherence (93% of visits were attended and a mean adherence rate of 97%). They found the reduction in HIV-1 RNA genital shedding was significantly greater in the valacyclovir arm vs. placebo group in which HIV-1 RNA showed a slight increase (\u00960.26 vs. +0.09 log copies\/mL, p= 0.003).<\/p>\n<p>HIV-1 shedding was significantly less persistent in the valacyclovir arm (14.3% vs. 27.1% shed at each visit; 27.1% vs. 44.3% shed at &gt;\/=50% of visits; 32.9% vs. 14.3% shed at &lt;50% of visits; and 25.7% vs. 14.3% never shed, p= 0.007).<\/p>\n<p>They also reported a reduction in HIV-1 plasma viral load in the valacyclovir arm (\u0096 0.39 vs. +0.12 log copies\/mL, p &lt;0.001) and HSV-2 DNA shedding (\u00960.22 vs. +0.18 log copies\/mL, p &lt;0.001). The proportion of women shedding HSV-2 at least once was 18.6% in the valacyclovir arm and 54.3% in the placebo arm (p &lt;0.001).<\/p>\n<p>Dr Nagot concluded that although this study was a proof of concept and had no direct public health implications, \u0093sustained HSV-2 control could: decrease genital transmissibility; have individual benefits on viral load or immunity and decrease HSW-1 transmission.\u0094 But at this stage the clinical implications are unclear.<\/p>\n<p class=\"ref\">Reference:<\/p>\n<p class=\"ref\">Effect of HSV-2 suppressive therapy on HIV-1 genital shedding and plasma viral load: A proof of concept randomised double-blind placebo controlled trial (ANRS 1285 Trial). Nagot N, Ouedraogo A, Mayaud P et al. 13th CROI, Denver, 2006. Abstract 33LB.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Polly Clayden, HIV i-Base Previous epidemiological data have suggested that herpes simplex virus 2 (HSV-2) infection can increase HIV-1 genital shedding, and in turn increase HIV-1 transmissibility among coinfected people. To date this causal relationship has never been demonstrated. In &hellip;<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,44],"tags":[60],"class_list":["post-3326","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-womens-health","tag-croi-2006"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/3326","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=3326"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/3326\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=3326"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=3326"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=3326"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}