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HSV-2 coinfection did not accelerate CD4 count decline
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Coinfection with herpes simplex virus type 2 did not lead to an accelerated CD4 count decline among those with untreated HIV, according to research published in Clinical Infectious Diseases.
“These results were surprising because a considerable body of literature has previously associated HSV-2 coinfection with increased HIV viral loads, which in turn is a major driver of the rate of HIV disease progression,” Darrell Tan, MD, PhD, of the division of infectious diseases at St. Michael’s Hospital and the department of medicine at the University of Toronto, told Infectious Disease News. “There have also been recent clinical trials showing that the anti-HSV drug acyclovir is associated with a modest attenuation in the rate of HIV disease in untreated coinfected adults. A major rationale for those trials was the assumption that HSV-2 was accelerating HIV disease.”
Darrell Tan
Tan and colleagues evaluated 218 patients with untreated HIV: 123 were positive for HSV-2 and 161 were positive for HSV-1. The initial CD4 cell counts ranged from 400 cells/mm3 to 900 cells/mm3, and no patients were receiving anti-HSV therapy. The researchers compared the CD4 cell count changes between those with HSV-2 coinfection and those without.
In a multivariable analysis that adjusted for sex, HSV-1 serostatus, oral and genital herpes symptoms, immigrant status and the interaction of immigrant status with time, there was no significant relationship between HSV-2 serostatus and the rate of CD4 decline. However, HSV-2 coinfection was associated with increased rate of disease progression, including a shorter time to ART initiation or a CD4 count of less than 350 cells/mm3 (HR=2.07; 95% CI, 1.28-3.33).
“We urge caution in using a patient’s HSV-2 status to prognosticate their future course of HIV infection,” Tan said. “That data suggest that knowing a patient is infected with HSV-2 does not necessarily imply that the patient will have a more rapid CD4 count decline. However, the findings do not negate the results of recent clinical trials showing that acyclovir may modestly delay HIV disease progression in patients with HSV-2 and untreated HIV.”
Tan said these data, and other recent data, question the underlying mechanisms by which acyclovir benefits HIV disease progression, learning whether it or related drugs act in vivo as antiretrovirals or have beneficial effects on HIV-related inflammation. Another unknown question is whether there are subsets of patients in whom HSV-2 accelerates HIV.
Darrell Tan, MD, PhD, can be reached at Darrell.tan@gmail.com.
Disclosure: Tan reports no relevant financial disclosures.
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