Nijhawan A E, Delong A K, Chapman S, Rana A, Kurpewski J, Ingersoll J, Caliendo A M, Cu-Uvin S
Division of General Internal Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Infect Dis Obstet Gynecol. 2012;2012:868526. doi: 10.1155/2012/868526. Epub 2012 Feb 28.
The role of suppressive HSV therapy in women coinfected with HSV-2 and HIV-1 taking highly active antiretroviral therapy (HAART) is unclear.
60 women with HIV-1/HSV-2 coinfection on HAART with plasma HIV-1 viral load (PVL) ≤75 copies/mL were randomized to receive acyclovir (N = 30) or no acyclovir (N = 30). PVL, genital tract (GT) HIV-1, and GT HSV were measured every 4 weeks for one year.
Detection of GT HIV-1 was not significantly different in the two arms (OR 1.23, P = 0.67), although this pilot study was underpowered to detect this difference. When PVL was undetectable, the odds of detecting GT HIV were 0.4 times smaller in the acyclovir arm than in the control arm, though this was not statistically significant (P = 0.07). The odds of detecting GT HSV DNA in women receiving acyclovir were significantly lower than in women in the control group, OR 0.38, P < 0.05.
Chronic suppressive therapy with acyclovir in HIV-1/HSV-2-positive women on HAART significantly reduces asymptomatic GT HSV shedding, though not GT HIV shedding or PVL. PVL was strongly associated with GT HIV shedding, reinforcing the importance of HAART in decreasing HIV sexual transmission.
对于同时感染单纯疱疹病毒2型（HSV - 2）和人类免疫缺陷病毒1型（HIV - 1）且正在接受高效抗逆转录病毒治疗（HAART）的女性，抑制性HSV治疗的作用尚不清楚。
60名接受HAART治疗且血浆HIV - 1病毒载量（PVL）≤75拷贝/毫升的HIV - 1/HSV - 2合并感染女性被随机分为两组，一组接受阿昔洛韦治疗（N = 30），另一组不接受阿昔洛韦治疗（N = 30）。在一年时间里，每4周测量一次PVL、生殖道（GT）HIV - 1和GT HSV。
尽管这项初步研究检测该差异的能力不足，但两组中GT HIV - 1的检测率无显著差异（比值比1.23，P = 0.67）。当PVL不可检测时，阿昔洛韦治疗组检测到GT HIV的几率比对照组小0.4倍，不过这在统计学上无显著意义（P = 0.07）。接受阿昔洛韦治疗的女性检测到GT HSV DNA的几率显著低于对照组女性，比值比0.38，P < 0.05。
对于接受HAART治疗的HIV - 1/HSV - 2阳性女性，使用阿昔洛韦进行慢性抑制性治疗可显著减少无症状GT HSV脱落，但不能减少GT HIV脱落或PVL。PVL与GT HIV脱落密切相关，这强化了HAART在减少HIV性传播方面的重要性。
