Another Blow to the Quest for Effective Biomedical HIV Prevention Strategies

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This post is from Center Director Christine Lubinski, who reported from the 2009 IAS conference.

The IAS conference may be over, but we have a late-breaking post and an important one at that: the disappointing results from a major study examining whether treatment for herpes could help reduce the risk of HIV transmission in discordant couples where one partner was co-infected with both HSV and HIV.

Dr. Connie Celum, an infectious disease physician and epidemiologist at the University of Washington, reported on the results of a clinical trial to test the hypothesis that HSV treatment could reduce HIV infectiousness. The trial enrolled 3,408 HIV-1 discordant couples. The HIV-positive partners were co-infected with HSV and were randomized to receive either acyclovir 400 mg orally twice daily or a placebo. A major undertaking, the trial covered 14 sites in east and southern Africa, and participants were followed for two years.

HIV-positive enrollees had to have a CD4 count of at least 250—meaning they were not eligible for ART by national guidelines. The HIV-negative partner could be either HSV negative or positive. The median CD4 count of the enrollees was 460. Sixty-five percent of the HIV-positive partners were women. Although HSV-2 suppression through acyclovir reduced plasma HIV-1 RNA concentrations and genital ulcers, it did not reduce the risk of HIV-1 transmission to infected partners.

Dr. J.R. Lingappa, also of the University of Washington, followed Dr. Celum’s presentation with an additional study report from the same cohort of patients—and a little brighter news. Among the participants dually infected with HSV-2 and HIV-1, daily acyclovir HSV-2 progression reduced the rate of CD4 decline, the need for ART and mortality compared to the placebo groups. He said further evaluation is needed to determine if the 17 percent reduction in HIV disease progression seen in the group taking acyclovir warrants using acyclovir as a public health intervention to slow progression in HIV-1 infected adults who do not yet require ART.

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