Daily acyclovir to decrease herpes simplex virus type 2 (HSV-2) transmission from HSV-2/HIV-1 coinfected persons

A randomized controlled trial

Andrew Mujugira, Amalia S. Magaret, Connie Celum, Jared M. Baeten, Jairam R. Lingappa, Rhoda Ashley Morrow, Kenneth Fife, Sinead Delany-Moretlwe, Guy De Bruyn, Elizabeth A. Bukusi, Etienne Karita, Saidi Kapiga, Lawrence Corey, Anna Wald, Mary Campbell, Robert W. Coombs, James P. Hughes, M. Juliana Mcelrath, James I. Mullins, David Coetzee & 19 others Edwin Were, Max Essex, Joseph Makhema, Elly Katabira, Allan Ronald, Susan Allen, Kayitesi Kayitenkore, Craig Cohen, William Kanweka, Bellington Vwalika, Rachel Manongi, Carey Farquhar, Grace John-Stewart, James Kiarie, Mubiana Inambao, Helen Rees, Glenda Gray, James Mcintyre, Nelly Rwamba Mugo

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background. Daily suppressive therapy with valacyclovir reduces risk of sexual transmission of herpes simplex virus type 2 (HSV-2) in HSV-2-serodiscordant heterosexual couples by 48%. Whether suppressive therapy reduces HSV-2 transmission from persons coinfected with HSV-2 and human immunodeficiency virus type 1 (HIV-1) is unknown.Methods. Within a randomized trial of daily acyclovir 400 mg twice daily in African HIV-1 serodiscordant couples, in which the HIV-1-infected partner was HSV-2 seropositive, we identified partnerships in which HIV-1-susceptible partners were HSV-2 seronegative to estimate the effect of acyclovir on risk of HSV-2 transmission.Results. We randomly assigned 911 HSV-2/HIV-1-serodiscordant couples to daily receipt of acyclovir or placebo. We observed 68 HSV-2 seroconversions, 40 and 28 in acyclovir and placebo groups, respectively (HSV-2 incidence, 5.1 cases per 100 person-years; hazard ratio [HR], 1.35 [95% confidence interval,. 83-2.20]; P =. 22). Among HSV-2-susceptible women, vaginal drying practices (adjusted HR, 44.35; P =. 004) and unprotected sex (adjusted HR, 9.91; P =. 002) were significant risk factors for HSV-2 acquisition; having more children was protective (adjusted HR, 0.47 per additional child; P =. 012). Among HSV-2-susceptible men, only age ≤30 years was associated with increased risk of HSV-2 acquisition (P =. 016).Conclusions. Treatment of African HSV-2/HIV-1-infected persons with daily suppressive acyclovir did not decrease risk of HSV-2 transmission to susceptible partners. More-effective prevention strategies to reduce HSV-2 transmission from HIV-1-infected persons are needed.

Original languageEnglish
Pages (from-to)1366-1374
Number of pages9
JournalJournal of Infectious Diseases
Volume208
Issue number9
DOIs
StatePublished - Nov 1 2013

Fingerprint

Human Herpesvirus 2
Acyclovir
HIV-1
Randomized Controlled Trials
valacyclovir
Placebos
Unsafe Sex
Heterosexuality

Keywords

  • acyclovir
  • Africa
  • HIV-1
  • HSV-2
  • serodiscordant couples
  • transmission

ASJC Scopus subject areas

  • Infectious Diseases
  • Immunology and Allergy

Cite this

Daily acyclovir to decrease herpes simplex virus type 2 (HSV-2) transmission from HSV-2/HIV-1 coinfected persons : A randomized controlled trial. / Mujugira, Andrew; Magaret, Amalia S.; Celum, Connie; Baeten, Jared M.; Lingappa, Jairam R.; Morrow, Rhoda Ashley; Fife, Kenneth; Delany-Moretlwe, Sinead; De Bruyn, Guy; Bukusi, Elizabeth A.; Karita, Etienne; Kapiga, Saidi; Corey, Lawrence; Wald, Anna; Campbell, Mary; Coombs, Robert W.; Hughes, James P.; Mcelrath, M. Juliana; Mullins, James I.; Coetzee, David; Were, Edwin; Essex, Max; Makhema, Joseph; Katabira, Elly; Ronald, Allan; Allen, Susan; Kayitenkore, Kayitesi; Cohen, Craig; Kanweka, William; Vwalika, Bellington; Manongi, Rachel; Farquhar, Carey; John-Stewart, Grace; Kiarie, James; Inambao, Mubiana; Rees, Helen; Gray, Glenda; Mcintyre, James; Rwamba Mugo, Nelly.

In: Journal of Infectious Diseases, Vol. 208, No. 9, 01.11.2013, p. 1366-1374.

Research output: Contribution to journalArticle

Mujugira, A, Magaret, AS, Celum, C, Baeten, JM, Lingappa, JR, Morrow, RA, Fife, K, Delany-Moretlwe, S, De Bruyn, G, Bukusi, EA, Karita, E, Kapiga, S, Corey, L, Wald, A, Campbell, M, Coombs, RW, Hughes, JP, Mcelrath, MJ, Mullins, JI, Coetzee, D, Were, E, Essex, M, Makhema, J, Katabira, E, Ronald, A, Allen, S, Kayitenkore, K, Cohen, C, Kanweka, W, Vwalika, B, Manongi, R, Farquhar, C, John-Stewart, G, Kiarie, J, Inambao, M, Rees, H, Gray, G, Mcintyre, J & Rwamba Mugo, N 2013, 'Daily acyclovir to decrease herpes simplex virus type 2 (HSV-2) transmission from HSV-2/HIV-1 coinfected persons: A randomized controlled trial', Journal of Infectious Diseases, vol. 208, no. 9, pp. 1366-1374. https://doi.org/10.1093/infdis/jit333
Mujugira, Andrew ; Magaret, Amalia S. ; Celum, Connie ; Baeten, Jared M. ; Lingappa, Jairam R. ; Morrow, Rhoda Ashley ; Fife, Kenneth ; Delany-Moretlwe, Sinead ; De Bruyn, Guy ; Bukusi, Elizabeth A. ; Karita, Etienne ; Kapiga, Saidi ; Corey, Lawrence ; Wald, Anna ; Campbell, Mary ; Coombs, Robert W. ; Hughes, James P. ; Mcelrath, M. Juliana ; Mullins, James I. ; Coetzee, David ; Were, Edwin ; Essex, Max ; Makhema, Joseph ; Katabira, Elly ; Ronald, Allan ; Allen, Susan ; Kayitenkore, Kayitesi ; Cohen, Craig ; Kanweka, William ; Vwalika, Bellington ; Manongi, Rachel ; Farquhar, Carey ; John-Stewart, Grace ; Kiarie, James ; Inambao, Mubiana ; Rees, Helen ; Gray, Glenda ; Mcintyre, James ; Rwamba Mugo, Nelly. / Daily acyclovir to decrease herpes simplex virus type 2 (HSV-2) transmission from HSV-2/HIV-1 coinfected persons : A randomized controlled trial. In: Journal of Infectious Diseases. 2013 ; Vol. 208, No. 9. pp. 1366-1374.
@article{15c2e209b2eb48fd80de69c701f72740,
title = "Daily acyclovir to decrease herpes simplex virus type 2 (HSV-2) transmission from HSV-2/HIV-1 coinfected persons: A randomized controlled trial",
abstract = "Background. Daily suppressive therapy with valacyclovir reduces risk of sexual transmission of herpes simplex virus type 2 (HSV-2) in HSV-2-serodiscordant heterosexual couples by 48{\%}. Whether suppressive therapy reduces HSV-2 transmission from persons coinfected with HSV-2 and human immunodeficiency virus type 1 (HIV-1) is unknown.Methods. Within a randomized trial of daily acyclovir 400 mg twice daily in African HIV-1 serodiscordant couples, in which the HIV-1-infected partner was HSV-2 seropositive, we identified partnerships in which HIV-1-susceptible partners were HSV-2 seronegative to estimate the effect of acyclovir on risk of HSV-2 transmission.Results. We randomly assigned 911 HSV-2/HIV-1-serodiscordant couples to daily receipt of acyclovir or placebo. We observed 68 HSV-2 seroconversions, 40 and 28 in acyclovir and placebo groups, respectively (HSV-2 incidence, 5.1 cases per 100 person-years; hazard ratio [HR], 1.35 [95{\%} confidence interval,. 83-2.20]; P =. 22). Among HSV-2-susceptible women, vaginal drying practices (adjusted HR, 44.35; P =. 004) and unprotected sex (adjusted HR, 9.91; P =. 002) were significant risk factors for HSV-2 acquisition; having more children was protective (adjusted HR, 0.47 per additional child; P =. 012). Among HSV-2-susceptible men, only age ≤30 years was associated with increased risk of HSV-2 acquisition (P =. 016).Conclusions. Treatment of African HSV-2/HIV-1-infected persons with daily suppressive acyclovir did not decrease risk of HSV-2 transmission to susceptible partners. More-effective prevention strategies to reduce HSV-2 transmission from HIV-1-infected persons are needed.",
keywords = "acyclovir, Africa, HIV-1, HSV-2, serodiscordant couples, transmission",
author = "Andrew Mujugira and Magaret, {Amalia S.} and Connie Celum and Baeten, {Jared M.} and Lingappa, {Jairam R.} and Morrow, {Rhoda Ashley} and Kenneth Fife and Sinead Delany-Moretlwe and {De Bruyn}, Guy and Bukusi, {Elizabeth A.} and Etienne Karita and Saidi Kapiga and Lawrence Corey and Anna Wald and Mary Campbell and Coombs, {Robert W.} and Hughes, {James P.} and Mcelrath, {M. Juliana} and Mullins, {James I.} and David Coetzee and Edwin Were and Max Essex and Joseph Makhema and Elly Katabira and Allan Ronald and Susan Allen and Kayitesi Kayitenkore and Craig Cohen and William Kanweka and Bellington Vwalika and Rachel Manongi and Carey Farquhar and Grace John-Stewart and James Kiarie and Mubiana Inambao and Helen Rees and Glenda Gray and James Mcintyre and {Rwamba Mugo}, Nelly",
year = "2013",
month = "11",
day = "1",
doi = "10.1093/infdis/jit333",
language = "English",
volume = "208",
pages = "1366--1374",
journal = "Journal of Infectious Diseases",
issn = "0022-1899",
publisher = "Oxford University Press",
number = "9",

}

TY - JOUR

T1 - Daily acyclovir to decrease herpes simplex virus type 2 (HSV-2) transmission from HSV-2/HIV-1 coinfected persons

T2 - A randomized controlled trial

AU - Mujugira, Andrew

AU - Magaret, Amalia S.

AU - Celum, Connie

AU - Baeten, Jared M.

AU - Lingappa, Jairam R.

AU - Morrow, Rhoda Ashley

AU - Fife, Kenneth

AU - Delany-Moretlwe, Sinead

AU - De Bruyn, Guy

AU - Bukusi, Elizabeth A.

AU - Karita, Etienne

AU - Kapiga, Saidi

AU - Corey, Lawrence

AU - Wald, Anna

AU - Campbell, Mary

AU - Coombs, Robert W.

AU - Hughes, James P.

AU - Mcelrath, M. Juliana

AU - Mullins, James I.

AU - Coetzee, David

AU - Were, Edwin

AU - Essex, Max

AU - Makhema, Joseph

AU - Katabira, Elly

AU - Ronald, Allan

AU - Allen, Susan

AU - Kayitenkore, Kayitesi

AU - Cohen, Craig

AU - Kanweka, William

AU - Vwalika, Bellington

AU - Manongi, Rachel

AU - Farquhar, Carey

AU - John-Stewart, Grace

AU - Kiarie, James

AU - Inambao, Mubiana

AU - Rees, Helen

AU - Gray, Glenda

AU - Mcintyre, James

AU - Rwamba Mugo, Nelly

PY - 2013/11/1

Y1 - 2013/11/1

N2 - Background. Daily suppressive therapy with valacyclovir reduces risk of sexual transmission of herpes simplex virus type 2 (HSV-2) in HSV-2-serodiscordant heterosexual couples by 48%. Whether suppressive therapy reduces HSV-2 transmission from persons coinfected with HSV-2 and human immunodeficiency virus type 1 (HIV-1) is unknown.Methods. Within a randomized trial of daily acyclovir 400 mg twice daily in African HIV-1 serodiscordant couples, in which the HIV-1-infected partner was HSV-2 seropositive, we identified partnerships in which HIV-1-susceptible partners were HSV-2 seronegative to estimate the effect of acyclovir on risk of HSV-2 transmission.Results. We randomly assigned 911 HSV-2/HIV-1-serodiscordant couples to daily receipt of acyclovir or placebo. We observed 68 HSV-2 seroconversions, 40 and 28 in acyclovir and placebo groups, respectively (HSV-2 incidence, 5.1 cases per 100 person-years; hazard ratio [HR], 1.35 [95% confidence interval,. 83-2.20]; P =. 22). Among HSV-2-susceptible women, vaginal drying practices (adjusted HR, 44.35; P =. 004) and unprotected sex (adjusted HR, 9.91; P =. 002) were significant risk factors for HSV-2 acquisition; having more children was protective (adjusted HR, 0.47 per additional child; P =. 012). Among HSV-2-susceptible men, only age ≤30 years was associated with increased risk of HSV-2 acquisition (P =. 016).Conclusions. Treatment of African HSV-2/HIV-1-infected persons with daily suppressive acyclovir did not decrease risk of HSV-2 transmission to susceptible partners. More-effective prevention strategies to reduce HSV-2 transmission from HIV-1-infected persons are needed.

AB - Background. Daily suppressive therapy with valacyclovir reduces risk of sexual transmission of herpes simplex virus type 2 (HSV-2) in HSV-2-serodiscordant heterosexual couples by 48%. Whether suppressive therapy reduces HSV-2 transmission from persons coinfected with HSV-2 and human immunodeficiency virus type 1 (HIV-1) is unknown.Methods. Within a randomized trial of daily acyclovir 400 mg twice daily in African HIV-1 serodiscordant couples, in which the HIV-1-infected partner was HSV-2 seropositive, we identified partnerships in which HIV-1-susceptible partners were HSV-2 seronegative to estimate the effect of acyclovir on risk of HSV-2 transmission.Results. We randomly assigned 911 HSV-2/HIV-1-serodiscordant couples to daily receipt of acyclovir or placebo. We observed 68 HSV-2 seroconversions, 40 and 28 in acyclovir and placebo groups, respectively (HSV-2 incidence, 5.1 cases per 100 person-years; hazard ratio [HR], 1.35 [95% confidence interval,. 83-2.20]; P =. 22). Among HSV-2-susceptible women, vaginal drying practices (adjusted HR, 44.35; P =. 004) and unprotected sex (adjusted HR, 9.91; P =. 002) were significant risk factors for HSV-2 acquisition; having more children was protective (adjusted HR, 0.47 per additional child; P =. 012). Among HSV-2-susceptible men, only age ≤30 years was associated with increased risk of HSV-2 acquisition (P =. 016).Conclusions. Treatment of African HSV-2/HIV-1-infected persons with daily suppressive acyclovir did not decrease risk of HSV-2 transmission to susceptible partners. More-effective prevention strategies to reduce HSV-2 transmission from HIV-1-infected persons are needed.

KW - acyclovir

KW - Africa

KW - HIV-1

KW - HSV-2

KW - serodiscordant couples

KW - transmission

UR - http://www.scopus.com/inward/record.url?scp=84885414788&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84885414788&partnerID=8YFLogxK

U2 - 10.1093/infdis/jit333

DO - 10.1093/infdis/jit333

M3 - Article

VL - 208

SP - 1366

EP - 1374

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

SN - 0022-1899

IS - 9

ER -