Herpes medication does not reduce the risk of HIV transmission from individuals with HIV and genital herpes, Dr Joseph Makhema revealed at a press briefing held last Thursday at the Botswana Harvard Partnership buildings in Gaborone.
He said a UW- led internationally study found out that herpes medication demonstrated modest reduction in HIV disease progression. Makhema, who was the leader of the study in Botswana Project Director for the Botswana Harvard Partnership, said the recently completed internationally multi center clinical trial was taken by people infected with both HIV and Herpes Simplex virus-2 (HSV-2). He explained that multiple studies have shown that frequent genital herpes recurrences increase the amount of HIV in the blood and genital tract. “The HIV is also shed from genital herpes ulcers and persons with such ulcers transmit HIV to others more efficiently,” he said.
He revealed that there were 325 couples enrolled in the study from Botswana in HIV discordant couples in which one partner is infected while the other is not. He said genital herpes is thought to be a factor in a substantial proportion of new infections in Africa. “A clinical trial of genital herpes suppression in HIV discordant couples is the most direct way to see if we can make a person less infectious and likely to transmit HIV to their partners,” Makhema revealed.
He indicated that the study did found out that acyclovir significantly reduced genital ulcers due to HSV-2 and modestly reduced HIV levels in the blood; consistent with what the preliminary studies of HSV-2 suppressive treatment had shown. “However, it appears that these effects were not sufficient to reduce the risk of HIV transmission,” he said.
The study, which began recruitment at the 14 African sites in November 2004, ended follow up in October 2008. The project director explained that the study was randomized; placebo-controlled and double-blinded meanings that both participants and care providers did not know which treatment the participants were receiving. He said both the placebo and treatment groups received standard HIV prevention services, which included being supplied with condoms, treated for other sexually transmitted infections and provided care for HIV infection. “All participants received extensive counseling both individually and as a couple throughout the study period on how to reduce the risk of infection,” Makhema said.
He pointed out that based on the findings from the study they now better understand the relationship between HIV levels and HIV transmission. He stated that this shows that the bar is higher than they anticipated for the amount of reduction in HIV levels needed in order to reduce HIV infectiousness and transmission. “This is relevant for other interventions such as anti-retroviral drugs to treat HIV, treatment of co-infections such as malaria, and therapeutic HIV vaccines. This understanding is a major contribution to HIV research that will help guide our new search for new HIV prevention and treatment strategies,” Makhema said.