Improvement in healing and reduction in HIV shedding with episodic acyclovir therapy as part of syndromic management among men: a randomized, controlled trial.

Abstract

BACKGROUND:

It is uncertain whether episodic acyclovir will enhance ulcer healing if delivered at primary health care settings, because there is often a delay in treatment initiation.

METHODS:

A double-blind, randomized, placebo-controlled trial of 5-day acyclovir (400 mg 3 times daily) was conducted among men with genital ulcers in South Africa. Participants received syndromic management; were tested for ulcer etiology, human immunodeficiency virus (HIV), syphilis, and herpes simplex virus type 2 (HSV-2); and were seen over the course of a month to evaluate ulcer healing and HIV-1 RNA shedding. Outcomes were ulcer duration and HIV-1 RNA shedding, assessed on day 7 among HIV-1-seropositive participants with a herpetic ulcer.

RESULTS:

A total of 309 men received acyclovir, and 306 received placebo; 63% were HIV-1 positive. There were 295 HIV-1-positive participants with a herpetic ulcer. Acyclovir improved ulcer healing--61% of those receiving acyclovir healed by day 7, compared with 42% of those receiving placebo (adjusted relative risk, 1.4 [95% confidence interval, 1.1-1.8]; P= .003). Acyclovir also improved healing by a median of 3 days (P= .002) and reduced HIV-1 ulcer shedding on day 7 (24% for acyclovir vs 37% for placebo; P= .05).

CONCLUSIONS:

Addition of acyclovir to syndromic management will improve healing of genital ulcers and may potentially reduce HIV transmission in combination with other interventions.

• Authors: Gabriela Paz-Bailey, Maya Sternberg, Adrian J Puren, Lauri E Markowitz, Ronald Ballard, Sinead Delany, Sarah Hawkes, Okey Nwanyanwu, Caroline Ryan, David A Lewis
• Journal: The Journal of infectious diseases (J Infect Dis) Vol. 200 Issue 7 Pg. 1039-49 (Oct 01 2009) ISSN: 0022-1899 [Print] United States
• PMID: 19715417 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Antiviral Agents
• Acyclovir

Topics

• Acyclovir (therapeutic use)
• Adolescent
• Adult
• Antiviral Agents (therapeutic use)
• Double-Blind Method
• HIV Infections (drug therapy, prevention & control, virology)
• HIV-1 (drug effects, genetics)
• Herpes Genitalis (drug therapy)
• Herpesvirus 2, Human (drug effects)
• Humans
• Male
• Middle Aged
• South Africa (epidemiology)
• Ulcer (drug therapy, virology)
• Virus Shedding (drug effects)
• Young Adult