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Acyclovir failed to lead to HIV resistance in patients with HSV-2
Baeten J.J lnfect Dis. 2011;203:117-121.
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Daily herpes simplex virus suppressive therapy combined with standard dose acyclovir did not result in HIV-resistance when administered in patients co-infected with HIV, according to Jared M. Baeten, MD, of the University of Washington.
Previous research indicated that acyclovir may directly inhibit HIV-1 replication and may choose a specific HIV-1 reverse transcriptase mutation (V75I) without an anti-HIV-1 effect, according to background information in the study.
For the current prospective study, Baeten and colleagues set out to examine the accuracy of this research. “We tested for the specific HIV-resistance in HIV-infected persons from four countries that had taken acyclovir or acyclovir-related medications for extended periods of time,” Baeten told Infectious Disease News.
The cohort included 168 patients coinfected with HIV-1 and herpes simplex virus (HSV-2) from three cohorts: 14 patients from the US, 31 from Peru, and 123 from Botswana and Kenya. Patients were exposed to daily HSV-2 suppressive therapy, acyclovir or valacyclovir between 8 weeks and 2 years.
The researchers tested plasma for HIV-1 genotypic resistance at reverse transcriptase codon 75; plasma samples were tested with the Oligonucleotide Ligation Assay (OLA) for detection of the V75I mutation.
There was no evidence of selection of HIV-1 genotypic resistance and no cases of the V75I mutation were identified (95% CI, 0-2.2).
Based on these results, researchers concluded that standard-dose acyclovir or valacyclovir does not select for HIV-1 resistance. “Our study is among the first assessments of whether standard doses of acyclovir and valacyclovir suppressive therapy select for specific HIV-1 resistance mutations in vivo, and our results thus do not confirm in vitro studies that found that high-dose acyclovir had direct anti-HIV-1 activity and selected V75I mutants resistant to acyclovir,” the researchers wrote.
“Physicians should be reassured that prescribing acyclovir or related medications to HIV-infected patients who also have herpes will not result in resistant HIV,” Baeten said. – by Ashley DeNyse
Disclosures: Dr. Baeten has no direct financial interest in any of the products mentioned in this article nor is he a paid consultant for any companies mentioned.
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