Daily treatment with
standard-dose aciclovir delays HIV disease progression and lowers viral load in
patients co-infected with herpes simplex virus-2 (HSV-2), results of a study
presented to the Sixth International AIDS Conference (IAS 2011) in Rome show.
Two more studies presented at the conference found that valaciclovir, aciclovir's sister drug, also reduced viral load in patients and slowed disease progression inpregnant and breastfeeding women.
The trial was conducted
in the Rakai district of Uganda and involved patients with a CD4 cell count
between 300 and 400 cells/mm3 who were ineligible for antiretroviral
Patients treated with
aciclovir were 27% less likely to start antiretroviral therapy than those in
the placebo arm. The benefits of aciclovir therapy were especially pronounced
for patients with a baseline viral load above 50,000 copies/ml.
Presenting the data, Dr
Steven Reynolds said the study was looking at “a new treatment strategy for an
A large proportion of
HIV-positive patients in sub-Saharan Africa are co-infected with HSV-2, and a
number of studies have shown that these patients have a higher HIV viral load
and faster HIV disease progression than those people without HSV-2.
There has been
previous interest in the use of aciclovir to slow HIV disease progression in
these patients, and it is known that therapy with this drug can achieve a
reduction in viral load of approximately 0.5 log10 copies/ml.
Although access to
antiretroviral therapy is increasing in sub-Saharan Africa, the majority of
patients are not eligible for treatment. Affordable strategies to delay HIV disease
progression are needed.
therefore designed a randomised controlled trial that included HIV/HSV-2
co-infected patients who were ineligible for HIV therapy. On entry to the
study, the patients’ median baseline CD4 cell count was 350 cells/mm3
and their median viral load was
4.44 log10 copies/ml.
A total of 440
patients were randomised. Patients in the treatment arm received standard aciclovir
therapy consisting of 400 mg twice daily. The control arm received a placebo.
The study lasted 24 months and the patients underwent detailed monitoring at
intervals of six months.
Three per cent of
patients were lost to follow-up and 3% died, but study retention was high and
excellent treatment adherence was reported.
There were no serious
Results clearly showed
that therapy with aciclovir slowed HIV disease progression.
Patients treated with
aciclovir were 27% less likely than individuals in the placebo arm to
experience a fall in their CD4 cell count below 200 cells/mm3 or to develop an AIDS-defining condition and therefore become eligible for HIV
therapy (AHR 0.73,
95% CI 0.56-0.97, p=0.029).
therapy was most beneficial for people with a baseline viral load above
50,000 copies/ml, reducing their need to initiate anti-HIV drugs by 38% when
compared to the placebo arm (AHR 0.62; 95% CI 0.43-0.96, p=0.03).
the benefits of aciclovir for patients with lower viral loads were less clear,
reducing their need to start antiretroviral therapy by a non-significant 10%.
with aciclovir also had a beneficial impact on HIV viral load, which fell by -0.061
log10 copies/ml in patients taking the drug. In contrast, viral load
increased by 0.402 log10 copies/ml among individuals in the placebo
“Aciclovir 400mg twice daily delayed disease
progression among HIV/HSV-2 co-infected individuals,” concluded Dr Reynolds, who
suggested aciclovir “treatment of
chronic HSV-2 infection may be warranted in HIV infected individuals”.
He called for further
research into the efficacy of the drug, but added that valaciclovir may have an
even bigger impact on disease progression.
study from Kenya showed valaciclovir reduced viral load in adults
third from Uganda found that another herpes drug, aciclovir, also
helped reduce disease progression.