Suppressive acyclovir therapy reduces HIV cervicovaginal shedding in HIV- and HSV-2-infected women, Chiang Rai, Thailand

Background: Herpes simplex virus type 2 infection is important is the HIV epidemic and may contribute to increased HIV transmission. We evaluated the effect Of Suppressive acyclovir therapy oil cervicovaginal HIV-1 shedding. Methods: HIV-1- and herpes simplex virus type 2-coinfected women aged 18-49 years with CD4 counts >200 cells/mu L 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 I viral load and plasma HIV-1 viral load was compared. Results: Sixty-seven women were enrolled; at baseline, median CD4 count was 366 cells/mu L, and median HIV-1 plasma viral load was 4.6 log(10) copies/mL. The mean cervicovaginal lavage HIV-1 viral load was 1.9 (SD 0.8) log(10) copies/mL during the acyclovir month and 2.2 (SD 0.7) log(10) copies/mL during the placebo month (P < 0.0001); the mean decrease in HIV was 0.3 log(10) copies/mL. The mean plasma HIV viral load during the acyclovir month (3.78 log(10) copies/mL) was reduced compared with the placebo month (4.26 log(10) 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.