Effects of Valcyclovir on markers of disease Progression in Postpartum Women Co-Infected with HIV-1 andHerpes Simplex Virus-2
Date
2012-06Author
Roxby, AlisonC.
Drake, Alison L.
Owuor, Francisca Ongecha
Kiarie, James N.
Richardson, Barbra
Matemo, Daniel N.
Overbaugh, Julie
Emery, Sandra
Stewart, Grace C. John
Wald, Anna
Farquhar, Carey
Type
ArticleLanguage
enMetadata
Show full item recordAbstract
Objective:
Herpes simplex virus type 2 (HSV-2) suppression has been shown to reduce HIV-1 disease progression in nonpregnant
women and men, but effects on pregnant and postpartum women have not been described.
Methods:
We analyzed data from a cohort of Kenyan women participating in a randomized clinical trial of HSV-2
suppression. Pregnant HIV-1-seropositive, HSV-2-seropositive women who were not eligible for antiretroviral therapy (WHO
stage 1–2, CD4.250 cells/ml) were randomized to either 500 mg valacyclovir or placebo twice daily from 34 weeks gestation
through 12 months postpartum. Women received zidovudine and single-dose nevirapine for prevention of mother-to-child
HIV-1 transmission. HIV-1 progression markers, including CD4 count and plasma HIV-1 RNA levels, were measured serially.
Multivariate linear regression was used to compare progression markers between study arms.
Results:
Of 148 women randomized, 136 (92%) completed 12 months of postpartum follow-up. While adjusted mean CD4
count at 12 months (565 cells/ml placebo arm, 638 cells/ml valacyclovir arm) increased from antenatal levels in both arms, the
mean CD4 count increase was 73 cells/ml higher in the valacyclovir arm than placebo arm (p=0.03). Mean increase in CD4
count was 154 cells/ml in the valacyclovir arm, almost double the increase of 78 cells/ml in the placebo arm. At 12 months,
adjusted HIV-1 RNA levels in the placebo arm increased by 0.66 log 1 0 copies/ml from baseline, and increased by only 0.21
log1 0 copies/ml in the valacyclovir arm (0.40 log 1 0 copies/ml difference, p=0.001).
Conclusion:
Women randomized to valacyclovir suppressive therapy during pregnancy and postpartum had greater
increases in CD4 counts and smaller increases in plasma HIV-1 RNA levels than women in the placebo arm. Valacyclovir
suppression during pregnancy and breastfeeding may improve outcomes and delay antiretroviral therapy for HIV-1/HSV2
co-infected women
URI
http://erepository.uonbi.ac.ke:8080/xmlui/handle/123456789/10236http://www.ncbi.nlm.nih.gov/pubmed/22701683
Citation
PLoS ONE vol.7(16) 2012Collections
- Faculty of Health Sciences (FHS) [10377]