Valacyclovir Suppressive Therapy Reduces Plasma and Breast Milk HIV-1 RNA Levels During Pregnancy and Postpartum: A Randomized Trial

Exploiting the Anti-HIV-1 Activity of Acyclovir: Suppression of Primary and Drug-Resistant HIV Isolates and Potentiation of the Activity by Ribavirin

“…Highly specific and potent anti-herpetic drugs were developed in the mid-1970s, making it possible to test these strategies in randomized clinical trials of HSV-2 suppressive therapy using ACV/vACV. These trials consistently demonstrated that such therapy resulted in increased survival and a decrease in HIV-1 load by 0.3 to 0.5 log 10 in plasma, semen, cervico-vaginal secretions, and rectal swabs (3,9,11,20,27,45,46) and by 0.5 log 10 in plasma during pregnancy (10). Although this effect is relatively small compared to that produced by the current potent anti-HIV cocktails, it is important to remember that the effect achieved by ACV monotherapy is similar to the monotherapy effect of zidovudine, which is one of the most efficient components of HAART (17).…”

“…In particular, ACV/vACV treatments are associated with a reduction of HIV-1 load in plasma, semen, cervico-vaginal secretions, and rectal swabs (3,9,11,20,27,45,46) and in plasma during pregnancy (10). Also, several clinical studies, as well as two meta-analyses of a total of 15 randomized clinical studies, demonstrate that ACV/vACV treatment delays progression to AIDS and prolongs the patient's survival (14,22).…”

Pregnant Women and Disclosure to Sexual Partners After Testing HIV-1–Seropositive During Antenatal Care

“…As part of a clinical trial using valacyclovir to reduce maternal HIV-1 RNA levels, 19 we followed pregnant women from their first antenatal HIV-1-seropositive test, enrolled them in the study if eligible at 34 weeks gestation, and continued following women until 1 year postpartum. We collected data on disclosure from women at study entry and again at study exit.…”

Short Communication: T Cell Activation in HIV-1/Herpes Simplex Virus-2-Coinfected Kenyan Women Receiving Valacyclovir

“…When compared to the main study results, which reported a relative reduction of HIV-1 RNA of 0.53 log 10 copies/ml at 1 year postpartum among women randomized to valacyclovir, 8 the subset of women in this nested study randomized to valacyclovir also had significant relative reductions in plasma HIV-1 RNA levels of 0.6 log 10 copies/ml at 6 months postpartum and 0.3 log 10 copies/ml at 12 months postpartum. Only seven (12%) women taking valacyclovir and 11 (19%) women taking placebo had a prior history of genital ulcer disease (GUD).…”

“…This study was nested within a randomized, double-blind clinical trial, evaluating the efficacy of 500 mg valacyclovir twice daily or matching placebo for reducing maternal HIV-1 RNA levels in plasma, genital secretions, and breast milk, as described by Drake et al 8 At 34 weeks gestation, participants provided written informed consent and were randomized; study drugs were taken from 34 weeks until 1 year postpartum. In addition to study drug, mothers received short-course prevention of mother-tochild (PMTCT) antiretroviral (ARV) regimens according to Kenyan national guidelines.…”