Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Reactivation of herpes simplex virus type 2 after initiation of antiretroviral therapy

TitleReactivation of herpes simplex virus type 2 after initiation of antiretroviral therapy
Publication TypeJournal Article
Year of Publication2013
AuthorsTobian, AA, Grabowski, MK, Serwadda, D, Newell, K, Ssebbowa, P, Franco, V, Nalugoda, F, Wawer, MJ, Gray, RH, Quinn, TC, Reynolds, SJ
JournalThe Journal of Infectious Diseases
Date PublishedSep 1
ISBN Number1537-6613 (Electronic)0022-1899 (Linking)
Accession Number23812240
KeywordsAcyclovir/administration & dosage, Adult, Anti-Retroviral Agents/administration & dosage, Antiretroviral Therapy, Highly Active/ methods, Coinfection/drug therapy/virology, Female, Herpes Genitalis/ complications/ virology, Herpesvirus 2, Human/ drug effects/physiology, HIV Infections/ complications/ drug therapy, Humans, Male, Middle Aged, Placebos/administration & dosage, Sexual and Reproductive Health, Uganda, Vagina/virology, Virus Activation, virus shedding, Young Adult

BACKGROUND: The association between initiation of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection and possible herpes simplex virus type 2 (HSV-2) shedding and genital ulcer disease (GUD) has not been evaluated. METHODS: GUD and vaginal HSV-2 shedding were evaluated among women coinfected with HIV and HSV-2 (n = 440 for GUD and n = 96 for HSV-2 shedding) who began ART while enrolled in a placebo-controlled trial of HSV-2 suppression with acyclovir in Rakai, Uganda. Monthly vaginal swabs were tested for HSV-2 shedding, using a real-time quantitative polymerase chain reaction assay. Prevalence risk ratios (PRRs) of GUD were estimated using log binomial regression. Random effects logistic regression was used to estimate odds ratios (ORs) of HSV-2 shedding. RESULTS: Compared with pre-ART values, GUD prevalence increased significantly within the first 3 months after ART initiation (adjusted PRR, 1.94; 95% confidence interval [CI], 1.04-3.62) and returned to baseline after 6 months of ART (adjusted PRR, 0.80; 95% CI, .35-1.80). Detection of HSV-2 shedding was highest in the first 3 months after ART initiation (adjusted OR, 2.58; 95% CI, 1.48-4.49). HSV-2 shedding was significantly less common among women receiving acyclovir (adjusted OR, 0.13; 95% CI, .04-.41). CONCLUSIONS: The prevalence of HSV-2 shedding and GUD increased significantly after ART initiation, possibly because of immune reconstitution inflammatory syndrome. Acyclovir significantly reduced both GUD and HSV-2 shedding and should be considered to mitigate these effects following ART initiation.