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| |  Acyclovir Fails to Prevent HIV Transmission in Discordant Couples: Presented at IAS By Ed Susman CAPE TOWN, South Africa -- July 23, 2009 -- Treatment with acyclovir does not protect against HIV transmission among discordant couples, researchers stated here at the 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention. In a multicentre study conducted in Africa, researchers enrolled 3,408 HIV-positive individuals who were coinfected with the herpes simplex virus-2 (HSV-2) and were in a regular sexual relationship with a partner who was HIV-negative. The couples were counselled on how to avoid transmission and were either treated with acyclovir 400 mg BID or a placebo. Connie Celum, MD, Global Health and Medicine, University of Washington, Seattle, Washington, presented results from the Partners in Prevention HSV/HIV Transmission Study, in a late-breaker presentation on July 22. After the couples were followed for about 2 years, researchers found no significant differences in the percentage of people who were infected in either the acyclovir arm (41 infections) or the placebo arm (43 infections). "We found there was no efficacy in the intention-to-treat analysis of all transmissions [P = 0.88]," Dr. Celum said. She analysed the results in a multitude of ways and yet could find no significant advantage to use of acyclovir in the prevention setting based on sex of the HIV-positive partner, genital ulcer disease, level of HIV in the blood at baseline, study drug adherence, circumcision status, or the HSV-2 status of the HIV-negative partner. As shown in other studies, Dr. Celum said acyclovir therapy did result in a 0.25 log10 fall in plasma HIV. "This study demonstrated that a larger effect of interventions in HIV-infected persons is needed to decrease HIV infections," she said. The study was undertaken because previous work had found that HSV-2 is highly prevalent in HIV-infected persons, reactivates frequently, and is associated with increased HIV concentrations in plasma and genital secretions. Therefore, the researchers theorised that suppressive HSV-2 therapy may reduce plasma and genital HIV-1 levels, and possibly reducing HIV transmission. Funding for this study was provided by the Bill and Melinda Gates Foundation. [Presentation title: Twice-Daily Acyclovir to Reduce HIV-1 Transmission From HIV-1 / HSV-2 Co-Infected Persons Within HIV-1 Serodiscordant Couples: A Randomized, Double-Blind, Placebo-Controlled Trial. Abstract WELBC101]
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