Abstract | BACKGROUND: The association between initiation of antiretroviral therapy (ART) for human immunodeficiency virus ( HIV) infection and possible herpes simplex virus type 2 (HSV-2) shedding and genital ulcer disease (GUD) has not been evaluated. METHODS: GUD and vaginal HSV-2 shedding were evaluated among women coinfected with HIV and HSV-2 (n = 440 for GUD and n = 96 for HSV-2 shedding) who began ART while enrolled in a placebo-controlled trial of HSV-2 suppression with acyclovir in Rakai, Uganda. Monthly vaginal swabs were tested for HSV-2 shedding, using a real-time quantitative polymerase chain reaction assay. Prevalence risk ratios ( PRRs) of GUD were estimated using log binomial regression. Random effects logistic regression was used to estimate odds ratios ( ORs) of HSV-2 shedding. RESULTS: Compared with pre-ART values, GUD prevalence increased significantly within the first 3 months after ART initiation (adjusted PRR, 1.94; 95% confidence interval [CI], 1.04-3.62) and returned to baseline after 6 months of ART (adjusted PRR, 0.80; 95% CI, .35-1.80). Detection of HSV-2 shedding was highest in the first 3 months after ART initiation (adjusted OR, 2.58; 95% CI, 1.48-4.49). HSV-2 shedding was significantly less common among women receiving acyclovir (adjusted OR, 0.13; 95% CI, .04-.41). CONCLUSIONS: The prevalence of HSV-2 shedding and GUD increased significantly after ART initiation, possibly because of immune reconstitution inflammatory syndrome. Acyclovir significantly reduced both GUD and HSV-2 shedding and should be considered to mitigate these effects following ART initiation.
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Authors | Aaron A R Tobian, Mary K Grabowski, David Serwadda, Kevin Newell, Paschal Ssebbowa, Veronica Franco, Fred Nalugoda, Maria J Wawer, Ronald H Gray, Thomas C Quinn, Steven J Reynolds, Rakai Health Sciences Program |
Journal | The Journal of infectious diseases
(J Infect Dis)
Vol. 208
Issue 5
Pg. 839-46
(Sep 01 2013)
ISSN: 1537-6613 [Electronic] United States |
PMID | 23812240
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anti-Retroviral Agents
- Placebos
- Acyclovir
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Topics |
- Acyclovir
(administration & dosage)
- Adult
- Anti-Retroviral Agents
(administration & dosage)
- Antiretroviral Therapy, Highly Active
(methods)
- Coinfection
(drug therapy, virology)
- Female
- HIV Infections
(complications, drug therapy)
- Herpes Genitalis
(complications, virology)
- Herpesvirus 2, Human
(drug effects, physiology)
- Humans
- Male
- Middle Aged
- Placebos
(administration & dosage)
- Uganda
- Vagina
(virology)
- Virus Activation
- Virus Shedding
- Young Adult
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