dc.contributor.author |
Jairam, R. Lingappa |
|
dc.contributor.author |
Jared, M. Baeten |
|
dc.contributor.author |
Anna, Wald |
|
dc.contributor.author |
James, P. Hughes |
|
dc.contributor.author |
Katherine, K. Thomas |
|
dc.contributor.author |
Andrew, Mujugira |
|
dc.contributor.author |
Nelly, Mugo |
|
dc.contributor.author |
Elizabeth, A. Bukusi |
|
dc.contributor.author |
Craig R., Cohen |
|
dc.contributor.author |
Elly, Katabira |
|
dc.contributor.author |
Allan, Ronald |
|
dc.contributor.author |
James, Kiarie |
|
dc.contributor.author |
Carey, Farquhar |
|
dc.contributor.author |
Grace, John Stewart |
|
dc.contributor.author |
Joseph, Makhema |
|
dc.contributor.author |
Myron, Essex |
|
dc.contributor.author |
Edwin, Were |
|
dc.contributor.author |
Kenneth, H. Fife |
|
dc.contributor.author |
Guy de, Bruyn |
|
dc.contributor.author |
Glenda, E. Gray |
|
dc.contributor.author |
James, McIntyre |
|
dc.contributor.author |
Rachel, Manongi |
|
dc.contributor.author |
Saidi, Kapiga |
|
dc.contributor.author |
David, Coetzee |
|
dc.contributor.author |
Susan, Allen |
|
dc.contributor.author |
Mubiana, Inambao |
|
dc.contributor.author |
Kayitesi, Kayitenkore |
|
dc.contributor.author |
Etienne, Karita |
|
dc.contributor.author |
William, Kanweka |
|
dc.contributor.author |
Sinead, Delany |
|
dc.contributor.author |
Helen, Rees |
|
dc.contributor.author |
Bellington, Vwalika |
|
dc.contributor.author |
Amalia, Magaret |
|
dc.contributor.author |
Richard S., Wang |
|
dc.contributor.author |
Lara, Kidoguchi |
|
dc.contributor.author |
Linda, Barnes |
|
dc.contributor.author |
Renee, Ridzon |
|
dc.contributor.author |
Lawrence, Corey |
|
dc.contributor.author |
Connie, Celum |
|
dc.date.accessioned |
2018-04-17T08:47:46Z |
|
dc.date.available |
2018-04-17T08:47:46Z |
|
dc.date.issued |
2010-05-05 |
|
dc.identifier.uri |
http://ir.mu.ac.ke:8080/xmlui/handle/123456789/937 |
|
dc.description.abstract |
Background—Well-tolerated medications that slow HIV-1 disease progression and delay initiation
of antiretroviral therapy (ART) are needed. Most HIV-1-infected persons are dually-infected with
herpes simplex virus type 2 (HSV-2). Daily HSV-2 suppression reduces plasma HIV-1 levels, but
whether HSV-2 suppression delays HIV-1 disease progression is unknown.
Methods—Within a randomized, placebo-controlled trial of HSV-2 suppressive therapy (acyclovir
400 mg orally bid) to decrease HIV-1 transmission, 3381 HSV-2/HIV-1 dually-infected heterosexual
Africans who at enrollment had CD4 counts ≥250 cells/mm3 and were not taking ART were followed
for up to 24 months. We evaluated the effect of acyclovir on HIV-1 disease progression, defined by
a primary composite endpoint of first occurrence of CD4 count <200 cells/mm3, ART initiation, or
non-trauma related death. As an exploratory analysis, we evaluated the endpoint of CD4 decline to
<350 cells/mm3.
Findings—At enrollment, median CD4 was 462 cells/mm3 and median HIV-1 plasma RNA was
4.1 log10 copies/mL. Acyclovir reduced risk of HIV-1 disease progression: 284 participants on
acyclovir versus 324 on placebo reached the primary endpoint (hazard ratio [HR] 0.84, 95%
confidence interval [CI] 0.71–0.98, p=0.03). Among participants with CD4 counts ≥350 cells/
mm3, acyclovir delayed risk of CD4 decline to <350 cells/mm3 (HR 0.81, 95% CI 0.71–0.93,
p=0.002).
Interpretation—HSV-2 suppression with acyclovir reduced the risk of HIV-1 disease progression
by 16% (95% CI 2–29%). The role of HSV-2 suppression in reducing HIV-1 disease progression
prior to ART initiation warrants consideration (ClinicalTrials.gov #NCT00194519 |
en_US |
dc.description.sponsorship |
US National Institutes of Health (National Institute of Mental Health R01
Emory-Rwanda-Zambia HIV Research Group |
en_US |
dc.language.iso |
en_US |
en_US |
dc.publisher |
NIH Lancet public access |
en_US |
dc.relation.ispartofseries |
doi:10.1016/S0140-6736(09)62038-9.; |
|
dc.subject |
HIV-1 disease progression |
en_US |
dc.subject |
HIV-1 discordant couples |
en_US |
dc.subject |
HSV-2; genital herpes |
en_US |
dc.subject |
herpes suppression |
en_US |
dc.subject |
acyclovir; randomized clinical trial |
en_US |
dc.title |
Daily Acyclovir Delays HIV-1 Disease Progression Among HIV-1/ HSV-2 Dually-Infected Persons: A Randomized Trial |
en_US |
dc.type |
Article |
en_US |