Question
Does acyclovir (herpes treatment) reduce the HIV viral load?
10 June 2010. Related: All topics, CD4 and viral load, Complications and coinfections, Supplements and herbs.
Hi there guys,
I have a question regarding Herpes and HIV co-infection. Since I become infected with HIV just over a year ago I have been prone to more regular Herpes outbreaks than before, and since both are viruses I was wondering whether that would add extra stress on my already affected immune system.
So I decided to research a little bit about it since the thought has been in my head for quite a while and I have found two articles on poz.com claiming that according to some clinical studies treating Herpes with acyclovir produces a reduction in the amount of HIV in the blood as it reduces the inflammation of the immune system due the suppression of one of the viruses and as second effect fewer CD4 cells production to combat both infection and therefore fewer CD4 available for HIV infection.
Just to give you some more information I am not on any treatment (HIV, herpes, etc) my CD4 was 550 last time and viral load 30,000. I would appreciate your views and opinion and maybe if you could put me in the right direction for another research report as I would like to talk to my doctor about it. Also I was thinking why my doctor has never explained this to me as it is a very important topic.
Thanks guys I do appreciate all the fantastic work you do and sorry if my question and argument is not clear.
Answer
Thank you for your question.
It is great that you are interested in current research regarding possible links between genital herpes (HSV-2) and HIV-1 infection.
It has been know for many years that acyclovir can reduced HIV viral load. A recent study from the Retroviurus Conference in 2010 referenced this as about 0.4 log reductions in viral load. This may be both directly (though an antiviral effect) and indirectly (by reducing inflammation, as you refer to).
Your doctor may not have mentioned this, because this level of effect on viral load is unlikely to have any clinical benefit on you HIV-related health.
There has also been a lot of research looking at the impact treatment of HSV-2 with acyclovir has on HIV infection. Initial studies in women in Burkino Faso who had both HSV-2 and HIV found that treatment of HSV-2 decreased the viral load in the blood plasma and the genital fluid. For more information on this trial pleas see this link.
However, further investigations about whether treatment of HSV-2 could prevent HIV-1 infection particularly in discordant couples (where one partner is HIV positive and one partner is HIV negative) found there to be no significant differences. This means that HIV-1 is still transferred even if acyclovir is being used as a prophylaxis or to treat HSV-2. For more information on this study please follow these links here and here
Whilst these trials showed that treatment of HSV-2 did not reduce infection rates of HIV-1, they also found that herpes suppression can slow HIV disease progression in some people. The study team calculated that for every 43 people treated with the acyclovir for a year, only one person would be show a slowing of HIV disease progression.
If you are having trouble with recurrent herpes then taking the drug valacyclovir has been shown to be more effective in HIV positive people. Maybe when you next see your HIV doctor you can discuss this with him/her. For more information please follow this link
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