Acyclovir and Transmission of HIV-1 from Persons Infected with HIV-1 and HSV-2

Suppressive therapy for herpes simplex virus 2 (HSV-2) has also been shown to reduce the levels of human immunodeficiency virus type 1 (HIV-1). However, in this placebo-controlled trial involving 3408 African couples who were discordant in serologic status for these two viruses, daily treatment with acyclovir did not reduce the frequency of HIV-1 transmission, despite a reduction in HIV-1 RNA levels and a 73% reduction in the occurrence of HSV-2–positive genital ulcers. In African couples who were discordant in serologic status for HIV-1 and HSV-2, daily treatment with acyclovir did not reduce the frequency of HIV-1 transmission, despite a reduction in HIV-1 RNA levels and a 73% reduction in the occurrence of HSV-2–positive genital ulcers. The seroprevalence of herpes simplex virus type 2 (HSV-2), the most common cause of genital ulcer disease worldwide, is 60 to 90% in populations with human immunodeficiency virus type 1 (HIV-1). 1 Clinical manifestations of HSV-2 range from unrecognized or mild genital symptoms in most persons with HIV-1 infection to severe genital ulcer disease in persons with advanced HIV-1 disease. 2 , 3 Genital shedding of the herpes simplex virus occurs on up to 30% of days in persons infected with HIV-1, often when they have no symptoms or observable lesions. 4 , 5 Laboratory and epidemiologic studies suggest that HSV-2 may increase the infectiousness . . .