Impact of aciclovir on genital and plasma HIV-1 RNA in HSV-2/HIV-1 co-infected women: a randomized placebo-controlled trial in South Africa.
Impact of aciclovir on genital and plasma HIV-1 RNA in HSV-2/HIV-1 co-infected women: a randomized placebo-controlled trial in South Africa.
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DOI：
10.1097/qad.0b013e32831db217
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发表时间：
2009-02-20
期刊：
影响因子：
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通讯作者：
Mayaud P
中科院分区：
文献类型：
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作者：
Delany S;Mlaba N;Clayton T;Akpomiemie G;Capovilla A;Legoff J;Belec L;Stevens W;Rees H;Mayaud P
一些研究表明，单纯疱疹病毒2型(HSV-2)可能会促进HIV-1的传播和疾病的进展。我们进行了一项随机、双盲、安慰剂对照试验，对300名尚未接受HAART的HSV-2/HIV-1合并感染的妇女进行为期3个月的阿昔洛韦400 mg bd治疗。参与者在随机前和每月访问时接受评估，为期3个月。主要结果是第3个月(M3)就诊时生殖器HIV-1RNA的检测和数量。还利用所有访问的数据进行了分析。观察治疗前后血浆HIV-1RNA、CD4+细胞计数及生殖器HSV-2DNA的变化。在M3，与安慰剂组相比，阿昔洛韦组可检测到生殖器艾滋病毒的女性较少，但这并不显著(61/132[46%]比71/137[52%]，风险比[RR]0.89，95%可信区间0.70至1.14，p=0.36)。M3时不同脱落者间HIV1RNA含量差异无统计学意义(+0.13log10拷贝/毫升，95%可信区间−为0.14~0.39)。然而，阿昔洛韦显著降低了所有就诊中HIV-1的脱落频率(调整后的优势比为0.57，95%可信区间为0.36至0.89)。阿昔洛韦组M3血浆HIV1RNA(−0.34log10拷贝/mL95%CI 0.15~0.54)、生殖器HSV2DNA(8%vs 20%，RR 0.37，95%CI 0.19~0.73)和生殖器溃疡(8%vs 18%，RR 0.43，95%CI 0.22~0.84)均显著降低。HSV-2抑制疗法通过降低HIV-1血浆病毒载量和改变生殖器中HIV-1的脱落模式，可能有助于减少HIV-1的性传播，并可能推迟启动HAART的要求。
Several studies suggest that herpes simplex virus type 2 (HSV-2) may enhance HIV-1 transmission and disease progression. We conducted a randomised, double-blind, placebo-controlled trial of aciclovir 400mg BD for 3 months in 300 HSV-2/HIV-1 co-infected women not yet on HAART. Participants were evaluated pre-randomisation and at monthly visits for 3 months. Primary outcomes were the detection and quantity of genital HIV-1 RNA at the month 3 (M3) visit. Analyses were also undertaken using data from all visits. The treatment effects on plasma HIV-1 RNA, CD4+ count and genital HSV-2 DNA were also assessed. At M3 fewer women has detectable genital HIV in the aciclovir group compared to placebo, but this was not significant (61/132 [46%] vs.71/137 [52%], risk ratio [RR] 0.89, 95%CI 0.70 to 1.14, p=0.36). There was also little difference in quantity of HIV-1 RNA among shedders (+0.13 log10 copies/mL, 95%CI −0.14 to 0.39) at M3. However, aciclovir significantly decreased the frequency of HIV-1 shedding over all visits (adjusted odds-ratio 0.57, 95%CI 0.36 to 0.89). Significant reductions in M3 plasma HIV-1 RNA (−0.34 log10 copies/mL 95%CI 0.15 to 0.54), genital HSV-2 DNA (8% vs. 20%, RR 0.37, 95%CI 0.19 to 0.73) and genital ulceration (8% vs. 18%, RR 0.43, 95%CI 0.22 to 0.84) were observed in the aciclovir group. HSV-2 suppressive therapy, by reducing HIV-1 plasma viral load and altering the pattern of genital HIV-1 shedding, may contribute to the reduction in sexual transmission of HIV-1 and may delay the requirement for HAART initiation.