HSV Medication and Its Relation with HIV Control Issue

There was a strong association between herpes simplex virus type 2 (HSV-2) and infection with human immunodeficiency virus type 1 (HIV-1). A studies showed that patients who were seropositive for HSV-2 had three times the risk of acquiring HIV-1, as compared with those who were seronegative for the virus. This data was used as background why this article which one of New England Medicine Journal was written.

According to the article, HSV suppressive therapy significantly reduces genital and plasma HIV-1 RNA levels in infected patients. And this finding could be usefull in HIV control issue. To establish a relationship between HSV-2 and HIV-1 replication, the researchers took a randomized, controlled study to determine whether HSV suppressive therapy reduces HIV-1 replication among dually infected women in Bobo-Dioulasso, Burkina Faso.

The researchers were Nicolas Nagot, M.D. and his colleagues from the Clinical Research Unit, London School of Hygiene and Tropical Medicine, Keppel St., London. They studied a randomized, double-blind, placebo-controlled trial of HSV suppressive therapy with valacyclovir (at a dose of 500 mg twice daily) in Burkina Faso among women who were seropositive for HIV-1 and HSV-2; all were ineligible for highly active antiretroviral therapy.

Serologic Assays and CD4+, HIV-1 RNA and HSV-2 DNA, and Vaginal Infections due to Trichomonas vaginalis and Candida albicans were analyzed in laboratory analysis.

As predicted, suppressive therapy with 500 mg of valacyclovir twice daily among women with HIV-1 infection proved very effective in reducing genital ulcerations and genital HSV-2 DNA. It suggested that sustained forms of HSV-2 control (either antiviral therapy or effective vaccination) may reduce HIV-1 transmission, assuming that a reduction in genital and plasma HIV-1 RNA levels is a proxy for decreased transmissibility.

This finding could be especially relevant among populations likely to play an important role in the dynamics of HIV transmission and among couples with discordant HIV status. At the individual level, the reduction in plasma HIV-1 RNA levels (with the likely reduction in CD4+ activation, which is responsible for T-lymphocyte depletion) may lead to immunologic benefit over a longer duration of valacyclovir treatment, thereby slowing the course of HIV-1 disease. In addition to individual benefit regarding clinical recurrence, HSV suppressive therapy could also have an effect on HSV-2 transmission.

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