Delany Sinéad, Mlaba Nonkululeko, Clayton Tim, Akpomiemie Godspower, Capovilla Alexio, Legoff Jerome, Belec Laurent, Stevens Wendy, Rees Helen, Mayaud Philippe
Reproductive Health & HIV Research Unit, University of Witwatersrand, Johannesburg, Republic of South Africa.
AIDS. 2009 Feb 20;23(4):461-9. doi: 10.1097/QAD.0b013e32831db217.
Several studies suggest that herpes simplex virus type 2 (HSV-2) may enhance HIV-1 transmission and disease progression.
We conducted a randomized, double-blind, placebo-controlled trial of aciclovir 400 mg twice daily for 3 months in 300 HSV-2/HIV-1 co-infected women not yet on highly active antiretroviral therapy (HAART). Participants were evaluated prerandomization 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 cell count and genital HSV-2 DNA were also assessed.
At M3 fewer women had 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% confidence interval (CI) 0.70-1.14; 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 (OR) 0.57, 95% CI 0.36-0.89]. Significant reductions in M3 plasma HIV-1 RNA (-0.34 log10 copies/ml, 95% CI 0.15-0.54), genital HSV-2 DNA (8 vs. 20%, RR 0.37, 95% CI 0.19-0.73) and genital ulceration (8 vs. 18%, RR 0.43, 95% CI 0.22-0.84) 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.
多项研究表明，2型单纯疱疹病毒（HSV - 2）可能会增强HIV - 1的传播及疾病进展。
我们对300名尚未接受高效抗逆转录病毒治疗（HAART）的HSV - 2/HIV - 1合并感染女性进行了一项随机、双盲、安慰剂对照试验，给予她们每天两次、每次400毫克的阿昔洛韦，持续3个月。在随机分组前以及随后3个月的每月随访中对参与者进行评估。主要结局是在第3个月（M3）随访时检测生殖器HIV - 1 RNA及其数量。还使用所有随访的数据进行了分析。同时评估了治疗对血浆HIV - 1 RNA、CD4细胞计数和生殖器HSV - 2 DNA的影响。
在M3时，与安慰剂组相比，阿昔洛韦组中生殖器可检测到HIV的女性较少，但差异不显著[61/132（46%）对71/137（52%），风险比（RR）0.89，95%置信区间（CI）0.70 - 1.14；P = 0.36]。在M3时，病毒排出者中HIV - 1 RNA的数量也几乎没有差异（+0.13 log10拷贝/毫升，95% CI -0.14至0.39）。然而，在所有随访中，阿昔洛韦显著降低了HIV - 1排出的频率[调整优势比（OR）0.57，95% CI 0.36 - 0.89]。在阿昔洛韦组中观察到M3时血浆HIV - 1 RNA（-0.34 log10拷贝/毫升，95% CI 0.15 - 0.54）、生殖器HSV - 2 DNA（8%对20%，RR 0.37，95% CI 0.19 - 0.73）和生殖器溃疡（8%对18%，RR 0.43，95% CI 0.22 - 0.84）均有显著降低。
HSV - 2抑制疗法通过降低HIV - 1血浆病毒载量并改变生殖器HIV - 1排出模式，可能有助于减少HIV - 1的性传播，并可能延迟开始HAART的需求。
