Acyclovir, as part of syndromic management, may improve ulcer healing and reduce HIV shedding

Syndromic management of patients with HIV and herpetic ulcers may be improved by the addition of acyclovir therapy, according to results of a recent study.

The study was conducted among men with genital ulcers in South Africa. It was a double-blind, randomized, placebo-controlled trial of five-day acyclovir. There were 309 men in the acyclovir arm and 306 men in the placebo arm. Participants in the acyclovir arm were administered 400 mg of the drug three times a day.

The rate of HIV in the study population was 63%. There were 295 patients with HIV who also had herpetic ulcers.

Syndromic management was used to treat the participants. They were tested for ulcer etiology, HIV, syphilis and herpes simplex virus type 2. During a one-month period, participants were evaluated for ulcer healing and HIV RNA shedding.

The primary endpoints were ulcer duration and HIV RNA shedding. These outcomes were assessed on day seven among patients with HIV who also had a herpetic ulcer.

Day seven results demonstrated that 61% of participants receiving acyclovir had been healed of the ulcer, compared with 42% of participants receiving placebo (RR, 1.4; 95% CI, 1.1-1.8). Other results from that time point indicated that HIV ulcer shedding was reduced more effectively in the acyclovir group (24%) than in the placebo group (37%) (P=.05).

Healing time was improved by a median of three days (P=.002) among patients receiving acyclovir.

The researchers said the addition of acyclovir to the syndromic management of genital ulcer disease may improve healing of genital ulcers and may potentially reduce HIV-transmission in combination with other interventions.

Paz-Bailey G et al. J Infect Dis. 2009;200:1039-1049.