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 |
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| Hlavní autori: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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Kidlington
Elsevier Ltd
06.03.2010
Elsevier 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. |
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| 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 |
| Author_xml | – sequence: 1 givenname: Jairam R surname: Lingappa fullname: Lingappa, Jairam R email: lingappa@u.washington.edu organization: Department of Global Health, Seattle, WA, USA – sequence: 2 givenname: Jared M surname: Baeten fullname: Baeten, Jared M organization: Department of Global Health, Seattle, WA, USA – sequence: 3 givenname: Anna surname: Wald fullname: Wald, Anna organization: Department of Medicine, Seattle, WA, USA – sequence: 4 givenname: James P surname: Hughes fullname: Hughes, James P organization: Department of Biostatistics, Seattle, WA, USA – sequence: 5 givenname: Katherine K surname: Thomas fullname: Thomas, Katherine K organization: Department of Medicine, Seattle, WA, USA – sequence: 6 givenname: Andrew surname: Mujugira fullname: Mujugira, Andrew organization: Department of Global Health, Seattle, WA, USA – sequence: 7 givenname: Nelly surname: Mugo fullname: Mugo, Nelly organization: Department of Global Health, Seattle, WA, USA – sequence: 8 givenname: Elizabeth A surname: Bukusi fullname: Bukusi, Elizabeth A organization: Department of Global Health, Seattle, WA, USA – sequence: 9 givenname: Craig R surname: Cohen fullname: Cohen, Craig R organization: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA – sequence: 10 givenname: Elly surname: Katabira fullname: Katabira, Elly organization: Infectious Disease Institute, Makerere University, Kampala, Uganda – sequence: 11 givenname: Allan surname: Ronald fullname: Ronald, Allan organization: Department of Medicine, University of Manitoba, Winnipeg, MB, Canada – sequence: 12 givenname: James surname: Kiarie fullname: Kiarie, James organization: Department of Obstetrics and Gynecology, University of Nairobi and Kenyatta National Hospital, Nairobi, Kenya – sequence: 13 givenname: Carey surname: Farquhar fullname: Farquhar, Carey organization: Department of Medicine, Seattle, WA, USA – sequence: 14 givenname: Grace John surname: Stewart fullname: Stewart, Grace John organization: Department of Medicine, Seattle, WA, USA – sequence: 15 givenname: Joseph surname: Makhema fullname: Makhema, Joseph organization: Botswana-Harvard Partnership, Gabarone, Botswana – sequence: 16 givenname: Myron surname: Essex fullname: Essex, Myron organization: Department of Immunology and Infectious Diseases, Harvard University, Cambridge, MA, USA – sequence: 17 givenname: Edwin surname: Were fullname: Were, Edwin organization: Department of Reproductive Health, Moi University, Eldoret, Kenya – sequence: 18 givenname: Kenneth H surname: Fife fullname: Fife, Kenneth H organization: Department of Medicine, Indiana University, Indianopolis, IN, USA – sequence: 19 givenname: Guy surname: de Bruyn fullname: de Bruyn, Guy organization: Perinatal HIV Research Unit, Johannesburg, South Africa – sequence: 20 givenname: Glenda E surname: Gray fullname: Gray, Glenda E organization: Perinatal HIV Research Unit, Johannesburg, South Africa – sequence: 21 givenname: James A surname: McIntyre fullname: McIntyre, James A organization: Perinatal HIV Research Unit, Johannesburg, South Africa – sequence: 22 givenname: Rachel surname: Manongi fullname: Manongi, Rachel organization: Kilimanjaro Christian Medical Centre, Moshi, Tanzania – sequence: 23 givenname: Saidi surname: Kapiga fullname: Kapiga, Saidi organization: Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK – sequence: 24 givenname: David surname: Coetzee fullname: Coetzee, David organization: Infectious Disease Epidemiology Unit, University of Cape Town, Cape Town, South Africa – sequence: 25 givenname: Susan surname: Allen fullname: Allen, Susan organization: School of Medicine and Rollins School of Public Health, Emory University, Atlanta, GA, USA – sequence: 26 givenname: Mubiana surname: Inambao fullname: Inambao, Mubiana organization: School of Medicine and Rollins School of Public Health, Emory University, Atlanta, GA, USA – sequence: 27 givenname: Kayitesi surname: Kayitenkore fullname: Kayitenkore, Kayitesi organization: School of Medicine and Rollins School of Public Health, Emory University, Atlanta, GA, USA – sequence: 28 givenname: Etienne surname: Karita fullname: Karita, Etienne organization: School of Medicine and Rollins School of Public Health, Emory University, Atlanta, GA, USA – sequence: 29 givenname: William surname: Kanweka fullname: Kanweka, William organization: School of Medicine and Rollins School of Public Health, Emory University, Atlanta, GA, USA – sequence: 30 givenname: Sinead surname: Delany fullname: Delany, Sinead organization: Reproductive Health and HIV Research Unit University of the Witwatersrand, Johannesburg, South Africa – sequence: 31 givenname: Helen surname: Rees fullname: Rees, Helen organization: Reproductive Health and HIV Research Unit University of the Witwatersrand, Johannesburg, South Africa – sequence: 32 givenname: Bellington surname: Vwalika fullname: Vwalika, Bellington organization: School of Medicine and Rollins School of Public Health, Emory University, Atlanta, GA, USA – sequence: 33 givenname: Amalia S surname: Magaret fullname: Magaret, Amalia S organization: Department of Laboratory Medicine University of Washington, Seattle, WA, USA – sequence: 34 givenname: Richard S surname: Wang fullname: Wang, Richard S organization: Department of Global Health, Seattle, WA, USA – sequence: 35 givenname: Lara surname: Kidoguchi fullname: Kidoguchi, Lara organization: Department of Global Health, Seattle, WA, USA – sequence: 36 givenname: Linda surname: Barnes fullname: Barnes, Linda organization: Department of Global Health, Seattle, WA, USA – sequence: 37 givenname: Renee surname: Ridzon fullname: Ridzon, Renee organization: Bill & Melinda Gates Foundation, Seattle, WA, USA – sequence: 38 givenname: Lawrence surname: Corey fullname: Corey, Lawrence organization: Department of Medicine, Seattle, WA, USA – sequence: 39 givenname: Connie surname: Celum fullname: Celum, Connie organization: Department of Global Health, Seattle, WA, USA |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22504256$$DView record in Pascal Francis |
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| ContentType | Journal Article |
| Copyright | 2010 Elsevier Ltd Elsevier Ltd 2015 INIST-CNRS Copyright Elsevier Limited Mar 6-Mar 12, 2010 |
| Copyright_xml | – notice: 2010 Elsevier Ltd – notice: Elsevier Ltd – notice: 2015 INIST-CNRS – notice: Copyright Elsevier Limited Mar 6-Mar 12, 2010 |
| CorporateAuthor | for the Partners in Prevention HSV/HIV Transmission Study Team |
| CorporateAuthor_xml | – name: for the Partners in Prevention HSV/HIV Transmission Study Team |
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| DOI | 10.1016/S0140-6736(09)62038-9 |
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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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