Smith C R, Pogany L, Auguste U, Steben M, Lau Tty
Centre for Communicable Diseases and Infection Control, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, ON.
Dalla Lana School of Public Health, University of Toronto, Toronto, ON.
Can Commun Dis Rep. 2016 Feb 4;42(2):37-44. doi: 10.14745/ccdr.v42i02a03.
Among individuals with genital herpes simplex virus (HSV), co-infection with human immunodeficiency virus (HIV) has been shown to increase the frequency and severity of HSV symptoms, HSV shedding, and risk of HSV transmission.
To assess whether suppressive antivirual therapy for genital HSV in an HIV-positive populatation prevents HSV transmission to a susceptible partner.
A systematic search of the literature was conducted using MEDLINE and EMBASE databases to identify randomized controlled trials published between January 2005 and June 2015. Inclusion criteria were trials written in English or French utilizing suppressive antiviral therapies for HSV. Studies had to report on outcomes related to HSV transmission from HIV-positive populations. Surrogate markers of HSV transmission risk, such as HSV detection and viral load, were also included. Articles underwent a risk of bias assessment, and those with low risk of bias underwent data extraction to complete a narrative synthesis.
This review identified thirteen papers. Only one study directly measured transmission of HSV. The overall transmission rate was <10%, and suppressive antiviral therapy had no significant protective effect (9% transmission rate in the acyclovir group vs. 6% in the placebo group; hazard ratio [HR]: 1.35, 95% CI: 0.83-2.20). The remaining 12 papers addressed surrogate markers of transmission risk: HSV detection and viral load. Suppressive acyclovir appears to be effective in reducing HSV detection among HIV-positive populations, but it does not appear to reduce viral load. Suppressive valacyclovir may be effective in reducing HSV detection and viral load among HIV-positive patients who are antiretroviral therapy (ART)-naïve, but its effect appears to be nullified among those concurrently on ART.
Based on current evidence, suppressive antiviral therapy may reduce HSV detection and viral load, but its impact on HSV transmission is unclear. Clinicians should caution HIV-positive patients with HSV that suppressive therapy may not reduce risk of HSV transmission to susceptible partners.
在单纯疱疹病毒（HSV）感染者中，合并感染人类免疫缺陷病毒（HIV）会增加HSV症状的频率和严重程度、HSV排毒以及HSV传播风险。
评估在HIV阳性人群中对生殖器HSV进行抑制性抗病毒治疗是否可预防HSV传播给易感伴侣。
使用MEDLINE和EMBASE数据库对文献进行系统检索，以识别2005年1月至2015年6月期间发表的随机对照试验。纳入标准为用英语或法语撰写的使用HSV抑制性抗病毒疗法的试验。研究必须报告与HIV阳性人群HSV传播相关的结果。还包括HSV传播风险的替代标志物，如HSV检测和病毒载量。对文章进行偏倚风险评估，对偏倚风险低的文章进行数据提取以完成叙述性综合分析。
本综述共识别出13篇论文。只有一项研究直接测量了HSV的传播。总体传播率<10%，抑制性抗病毒治疗无显著保护作用（阿昔洛韦组传播率为9%，安慰剂组为6%；风险比[HR]：1.35，95%CI：0.83 - 2.20）。其余12篇论文涉及传播风险的替代标志物：HSV检测和病毒载量。阿昔洛韦抑制疗法似乎可有效降低HIV阳性人群中的HSV检测率，但似乎不能降低病毒载量。伐昔洛韦抑制疗法可能对未接受抗逆转录病毒治疗（ART）的HIV阳性患者降低HSV检测和病毒载量有效，但在同时接受ART的患者中其效果似乎被抵消。
基于目前的证据，抑制性抗病毒治疗可能会降低HSV检测和病毒载量，但其对HSV传播的影响尚不清楚。临床医生应告诫患有HSV的HIV阳性患者，抑制疗法可能无法降低HSV传播给易感伴侣的风险。
