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Herpes Treatment May Help Fight HIV

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Daily treatment with antivirals for HSV in women co-infected with both HSV and HIV can reduce the amount of HIV found in both blood and vaginal secretions, according to a new study published in the February 22 issue of the New England Journal of Medicine. The findings could have significant implications for HIV prevention.

An international group of researchers conducted a randomized, double-blind, placebo-controlled trial of HSV suppressive therapy with valacyclovir in Burkina Faso among 136 women infected with both HIV-1 and HSV-2. The results showed that having the herpes virus increased the replication of HIV, and also revealed that the quantity of HIV in the blood and vaginal secretions was reduced with daily treatment over 3 months.

As discussed in the last issue of The Helper, HSV and HIV act upon and enhance one another in various ways. For example, HSV-2 may influence the replication of HIV and accelerate the course of HIV disease. HSV-2 infection, in turn, has been shown to increase the risk of acquiring HIV.

Lead author Dr. Nicolas Nagot, of the London School of Hygiene & Tropical Medicine commented on the implications of the trial for future prevention efforts: “The results of the trial are striking. They show that valacyclovir significantly reduces the frequency and quantity of HIV detectable in genital secretions and, in addition, reduces the quantity of HIV in the plasma. As expected, there was also dramatic reduction in the detection of symptomatic and asymptomatic presence of HSV-2. The effects appeared to gradually increase over the 3 month follow-up period, with no sign of abating.”

While the findings will need to be confirmed by further research, they indicate a new way to possibly reduce the sexual transmission of HIV from already infected individuals to their partners. Dr Philippe Mayaud, one of Dr Nagot’s colleagues, noted, “Our results have important potential implications for public health and clinical practice, as HSV-2 control could become a new form of HIV prevention targeting HIV-infected individuals, as well as providing clinical benefits.”

Dr. Nagot also suggests that the results reinforce the need to focus on herpes vaccine development. “Importantly, an HSV vaccine that would either prevent HSV infection or diminish the clinical and subclinical manifestations of HSV with a similar efficacy on HIV as HSV suppressive therapy, would represent a long-lasting form of HIV prevention. The development and evaluation of an HSV vaccine should rank high on the international research agenda.”


Topical Treatment Shown to Reduce HSV-2 Shedding

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While a clinical trial of a topical herpes treatment was ended early by sponsors 3M and Eli Lilly and Co., recently published findings from the trial indicate that the experimental treatment showed promise in decreasing HSV-2 shedding rates.

The trial examined the investigational drug resiquimod, an immune response modifier that works by boosting the body’s ability to fight off infection. HSV2-positive trial participants applied resiquimod gel (or a placebo) topically two times per week for three weeks and then collected anogenital swabs for 60 days thereafter, so researchers could assess shedding rates through PCR testing. For the next seven months, participants treated any recurrences with the gel (resiquimod or placebo), followed by another 60-day period where they collected daily swabs once again. Couple

The study revealed that the median shedding rate (the per-person rate of days where swabs revealed detectable HSV DNA) was lower for those in the resiquimod group than the placebo group in both of the 60day sampling periods. Additionally, the resiquimod group experienced fewer days with lesions with an annualized recurrence rate 30% lower than that of the placebo group.

The study authors do note several limitations to the study, including the small study size, incomplete follow-up, and the early termination of the study by the sponsors when other studies of resiquimod conducted at the same time failed to show any effect. Despite these limitations, however, they acknowledge that this study is the first human randomized clinical trial to demonstrate decreased viral shedding after topical treatment with resiquimod.

As they conclude, “Resiquimod is the first drug to show posttreatment efficacy in human genital herpes. Treatment with an intermittently administered drug that reduces subsequent recurrences and viral shedding via modulation of HSV-specific immunity might be preferable over daily suppressive therapy for some persons with genital herpes. Furthermore, if such treatment could lead to long-term reduction in HSV-2 shedding, it might reduce the risk of genital herpes transmission.”

The full article on the trial, appeared in the May 7, 2007 issue of the Journal of Infectious Diseases.


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