Daily aciclovir for HIV-1 disease progression in people dually infected with HIV-1 and herpes simplex virus type 2: a randomised placebo-controlled trial

Most people infected with HIV-1 are dually infected with herpes simplex virus type 2. Daily suppression of this herpes virus reduces plasma HIV-1 concentrations, but whether it delays HIV-1 disease progression is unknown. We investigated the effect of aciclovir on HIV-1 progression. In a trial with...

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Vydané v:The Lancet (British edition) Ročník 375; číslo 9717; s. 824 - 833
Hlavní autori: Lingappa, Jairam R, Baeten, Jared M, Wald, Anna, Hughes, James P, Thomas, Katherine K, Mujugira, Andrew, Mugo, Nelly, Bukusi, Elizabeth A, Cohen, Craig R, Katabira, Elly, Ronald, Allan, Kiarie, James, Farquhar, Carey, Stewart, Grace John, Makhema, Joseph, Essex, Myron, Were, Edwin, Fife, Kenneth H, de Bruyn, Guy, Gray, Glenda E, McIntyre, James A, Manongi, Rachel, Kapiga, Saidi, Coetzee, David, Allen, Susan, Inambao, Mubiana, Kayitenkore, Kayitesi, Karita, Etienne, Kanweka, William, Delany, Sinead, Rees, Helen, Vwalika, Bellington, Magaret, Amalia S, Wang, Richard S, Kidoguchi, Lara, Barnes, Linda, Ridzon, Renee, Corey, Lawrence, Celum, Connie
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Kidlington Elsevier Ltd 06.03.2010
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Elsevier Limited
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ISSN:0140-6736, 1474-547X
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Abstract Most people infected with HIV-1 are dually infected with herpes simplex virus type 2. Daily suppression of this herpes virus reduces plasma HIV-1 concentrations, but whether it delays HIV-1 disease progression is unknown. We investigated the effect of aciclovir on HIV-1 progression. In a trial with 14 sites in southern Africa and east Africa, 3381 heterosexual people who were dually infected with herpes simplex virus type 2 and HIV-1 were randomly assigned in a 1:1 ratio to aciclovir 400 mg orally twice daily or placebo, and were followed up for up to 24 months. Eligible participants had CD4 cell counts of 250 cells per μL or higher and were not taking antiretroviral therapy. We used block randomisation, and patients and investigators were masked to treatment allocation. Effect of aciclovir on HIV-1 disease progression was defined by a primary composite endpoint of first occurrence of CD4 cell counts of fewer than 200 cells per μL, antiretroviral therapy initiation, or non-trauma related death. As an exploratory analysis, we assessed the endpoint of CD4 falling to <350 cells per μL. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00194519. At enrolment, the median CD4 cell count was 462 cells per μL and median HIV-1 plasma RNA was 4·1 log 10 copies per μL. Aciclovir reduced risk of HIV-1 disease progression by 16%; 284 participants assigned aciclovir versus 324 assigned placebo reached the primary endpoint (hazard ratio [HR] 0·84, 95% CI 0·71–0·98, p=0·03). In those with CD4 counts ≥350 cells per μL, aciclovir delayed risk of CD4 cell counts falling to <350 cells per μL by 19% (0·81, 0·71–0·93, p=0·002) The role of suppression of herpes simplex virus type 2 in reduction of HIV-1 disease progression before initiation of antiretroviral therapy warrants consideration. Bill & Melinda Gates Foundation.
AbstractList Most people infected with HIV-1 are dually infected with herpes simplex virus type 2. Daily suppression of this herpes virus reduces plasma HIV-1 concentrations, but whether it delays HIV-1 disease progression is unknown. We investigated the effect of aciclovir on HIV-1 progression. In a trial with 14 sites in southern Africa and east Africa, 3381 heterosexual people who were dually infected with herpes simplex virus type 2 and HIV-1 were randomly assigned in a 1:1 ratio to aciclovir 400 mg orally twice daily or placebo, and were followed up for up to 24 months. Eligible participants had CD4 cell counts of 250 cells per µL or higher and were not taking antiretroviral therapy. We used block randomisation, and patients and investigators were masked to treatment allocation. Effect of aciclovir on HIV-1 disease progression was defined by a primary composite endpoint of first occurrence of CD4 cell counts of fewer than 200 cells per µL, antiretroviral therapy initiation, or nontrauma related death. As an exploratory analysis, we assessed the endpoint of CD4 falling to <350 cells per µL. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00194519. At enrolment, the median CD4 cell count was 462 cells per µL and median HIV-1 plasma RNA was 4.1 log^sub 10^ copies per µL. Aciclovir reduced risk of HIV-1 disease progression by 16%; 284 participants assigned aciclovir versus 324 assigned placebo reached the primary endpoint (hazard ratio [HR] 0.84, 95% CI 0.71-0.98, p=0.03). In those with CD4 counts ≥350 cells per µL, aciclovir delayed risk of CD4 cell counts falling to <350 cells per µL by 19% (0.81, 0.71-0.93, p=0.002). The role of suppression of herpes simplex virus type 2 in reduction of HIV-1 disease progression before initiation of antiretroviral therapy warrants consideration. Bill & Melinda Gates Foundation.
Summary Background Most people infected with HIV-1 are dually infected with herpes simplex virus type 2. Daily suppression of this herpes virus reduces plasma HIV-1 concentrations, but whether it delays HIV-1 disease progression is unknown. We investigated the effect of aciclovir on HIV-1 progression. Methods In a trial with 14 sites in southern Africa and east Africa, 3381 heterosexual people who were dually infected with herpes simplex virus type 2 and HIV-1 were randomly assigned in a 1:1 ratio to aciclovir 400 mg orally twice daily or placebo, and were followed up for up to 24 months. Eligible participants had CD4 cell counts of 250 cells per μL or higher and were not taking antiretroviral therapy. We used block randomisation, and patients and investigators were masked to treatment allocation. Effect of aciclovir on HIV-1 disease progression was defined by a primary composite endpoint of first occurrence of CD4 cell counts of fewer than 200 cells per μL, antiretroviral therapy initiation, or non-trauma related death. As an exploratory analysis, we assessed the endpoint of CD4 falling to <350 cells per μL. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov , number NCT00194519. Findings At enrolment, the median CD4 cell count was 462 cells per μL and median HIV-1 plasma RNA was 4·1 log10 copies per μL. Aciclovir reduced risk of HIV-1 disease progression by 16%; 284 participants assigned aciclovir versus 324 assigned placebo reached the primary endpoint (hazard ratio [HR] 0·84, 95% CI 0·71–0·98, p=0·03). In those with CD4 counts ≥350 cells per μL, aciclovir delayed risk of CD4 cell counts falling to <350 cells per μL by 19% (0·81, 0·71–0·93, p=0·002) Interpretation The role of suppression of herpes simplex virus type 2 in reduction of HIV-1 disease progression before initiation of antiretroviral therapy warrants consideration. Funding Bill & Melinda Gates Foundation.
Most people infected with HIV-1 are dually infected with herpes simplex virus type 2. Daily suppression of this herpes virus reduces plasma HIV-1 concentrations, but whether it delays HIV-1 disease progression is unknown. We investigated the effect of aciclovir on HIV-1 progression. Methods - In a trial with 14 sites in southern Africa and east Africa, 3381 heterosexual people who were dually infected with herpes simplex virus type 2 and HIV-1 were randomly assigned in a 1:1 ratio to aciclovir 400 mg orally twice daily or placebo, and were followed up for up to 24 months. Eligible participants had CD4 cell counts of 250 cells per kL or higher and were not taking antiretroviral therapy. We used block randomisation, and patients and investigators were masked to treatment allocation. Effect of aciclovir on HIV-1 disease progression was defined by a primary composite endpoint of first occurrence of CD4 cell counts of fewer than 200 cells per kL, antiretroviral therapy initiation, or non-trauma related death. As an exploratory analysis, we assessed the endpoint of CD4 falling to <350 cells per kL. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00194519. Findings - At enrolment, the median CD4 cell count was 462 cells per kL and median HIV-1 plasmaA was 4 super(.1) log sub(10) copies per kL. Aciclovir reduced risk of HIV-1 disease progression by 16%; 284 participants assigned aciclovir versus 324 assigned placebo reached the primary endpoint (hazard ratio [HR] 0 super(.84, 95% CI) 0 super(.71-0.98), p=0 super(.03)). In those with CD4 counts >=350 cells per kL, aciclovir delayed risk of CD4 cell counts falling to <350 cells per kL by 19% (0 super(.81, 0.71-0.93), p=0 super(.002)) Interpretation - The role of suppression of herpes simplex virus type 2 in reduction of HIV-1 disease progression before initiation of antiretroviral therapy warrants consideration. Funding - Bill & Melinda Gates Foundation.
Most people infected with HIV-1 are dually infected with herpes simplex virus type 2. Daily suppression of this herpes virus reduces plasma HIV-1 concentrations, but whether it delays HIV-1 disease progression is unknown. We investigated the effect of aciclovir on HIV-1 progression. In a trial with 14 sites in southern Africa and east Africa, 3381 heterosexual people who were dually infected with herpes simplex virus type 2 and HIV-1 were randomly assigned in a 1:1 ratio to aciclovir 400 mg orally twice daily or placebo, and were followed up for up to 24 months. Eligible participants had CD4 cell counts of 250 cells per μL or higher and were not taking antiretroviral therapy. We used block randomisation, and patients and investigators were masked to treatment allocation. Effect of aciclovir on HIV-1 disease progression was defined by a primary composite endpoint of first occurrence of CD4 cell counts of fewer than 200 cells per μL, antiretroviral therapy initiation, or non-trauma related death. As an exploratory analysis, we assessed the endpoint of CD4 falling to <350 cells per μL. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00194519. At enrolment, the median CD4 cell count was 462 cells per μL and median HIV-1 plasma RNA was 4·1 log 10 copies per μL. Aciclovir reduced risk of HIV-1 disease progression by 16%; 284 participants assigned aciclovir versus 324 assigned placebo reached the primary endpoint (hazard ratio [HR] 0·84, 95% CI 0·71–0·98, p=0·03). In those with CD4 counts ≥350 cells per μL, aciclovir delayed risk of CD4 cell counts falling to <350 cells per μL by 19% (0·81, 0·71–0·93, p=0·002) The role of suppression of herpes simplex virus type 2 in reduction of HIV-1 disease progression before initiation of antiretroviral therapy warrants consideration. Bill & Melinda Gates Foundation.
Author Magaret, Amalia S
Coetzee, David
Kapiga, Saidi
Lingappa, Jairam R
Allen, Susan
Inambao, Mubiana
Mujugira, Andrew
McIntyre, James A
Karita, Etienne
Katabira, Elly
Delany, Sinead
Makhema, Joseph
Gray, Glenda E
Wald, Anna
Kanweka, William
Vwalika, Bellington
Kidoguchi, Lara
Corey, Lawrence
Wang, Richard S
Cohen, Craig R
Were, Edwin
Barnes, Linda
Ridzon, Renee
Manongi, Rachel
Thomas, Katherine K
de Bruyn, Guy
Ronald, Allan
Kayitenkore, Kayitesi
Farquhar, Carey
Celum, Connie
Essex, Myron
Mugo, Nelly
Kiarie, James
Stewart, Grace John
Rees, Helen
Fife, Kenneth H
Bukusi, Elizabeth A
Baeten, Jared M
Hughes, James P
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  organization: Department of Global Health, Seattle, WA, USA
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  organization: Department of Global Health, Seattle, WA, USA
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  organization: Department of Medicine, Seattle, WA, USA
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  organization: Infectious Disease Institute, Makerere University, Kampala, Uganda
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  organization: Department of Global Health, Seattle, WA, USA
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Issue 9717
Keywords Acyclic nucleoside
Purine nucleoside
Prognosis
HIV-1 virus
Alphaherpesvirinae
Daily
Aciclovir
Human herpesvirus 2
Nucleoside analog
Antiviral
Clinical trial
Evolution
DNA polymerase inhibitor
Immunopathology
Herpesviridae
Retroviridae
AIDS
Immune deficiency
Lentivirus
Randomized controlled trial
Infection
Virus
Medicine
Viral disease
Placebo
Human immunodeficiency virus
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Snippet Most people infected with HIV-1 are dually infected with herpes simplex virus type 2. Daily suppression of this herpes virus reduces plasma HIV-1...
Summary Background Most people infected with HIV-1 are dually infected with herpes simplex virus type 2. Daily suppression of this herpes virus reduces plasma...
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SubjectTerms Antibiotics. Antiinfectious agents. Antiparasitic agents
Antiretroviral agents
Antiviral agents
Biological and medical sciences
Disease transmission
General aspects
Herpes viruses
Herpesvirus
HIV
Human immunodeficiency virus
Human subjects
Human viral diseases
Infectious diseases
Internal Medicine
Medical sciences
Mortality
Pharmacology. Drug treatments
Plasma
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
Title Daily aciclovir for HIV-1 disease progression in people dually infected with HIV-1 and herpes simplex virus type 2: a randomised placebo-controlled trial
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Volume 375
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