Effectiveness of Acyclovir in Suppressing HIV Viral Load in Women Coinfected With HIV and Herpes Simplex Virus Type 2 (HSV-2)
Information source: National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.
Condition(s) targeted: HIV Infections; Herpesvirus 2, Human
Intervention: Acyclovir (Drug); Acyclovir placebo (Drug)
Phase: Phase 2
Sponsored by: National Institute of Allergy and Infectious Diseases (NIAID)
Official(s) and/or principal investigator(s):
Aldo Lucchetti, MD, Study Chair, Affiliation: Asociación Civil Impacta Salud y Educación, Lima, Peru
Connie Celum, MD, MPH, Study Chair, Affiliation: University of Washington
The purpose of this study is to determine whether acyclovir is effective in suppressing HIV
viral load in women infected with both HIV-1 and herpes simplex virus type 2 (HSV-2) who are
starting HIV treatment for the first time.
Official title: A Phase II, Randomized, Double-blind, Placebo-controlled Trial of Acyclovir for the Suppression of Human Immunodeficiency Virus Type 1 (HIV-1) Viral Load and Mucosal Shedding in HIV-1, Herpes Simplex Virus, Type 2 (HSV-2) Co-Infected Women
Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver), Primary Purpose: Treatment
Primary outcome: Undetectable HIV plasma RNA viral load (less than 50 copies/ml)
Undetectable HIV plasma RNA viral load (less than 50 copies/ml)
Time to undetectable HIV plasma RNA viral load (less than 50 copies/ml), adjusted for baseline viral load
Intermittent episodes of detectable HIV plasma RNA viral load (greater than 200 copies/ml)
Positive HIV PCR test on vaginal mucosal samples
Women coinfected with HIV and HSV-2 experience more genital herpes outbreaks than women
infected only with HSV-2. Frequent or recurrent herpes outbreaks in women infected with HIV
can lead to an increase in both HIV plasma viral load and cervical shedding of HIV. Some
preliminary clinical studies have shown that acyclovir treatment for the management of HSV-2
infection can help lower HIV viral load in patients coinfected with both HIV and HSV-2.
Supplementing highly active antiretroviral therapy (HAART) with HSV-2 treatment in patients
coinfected with both HIV and HSV-2 may help strengthen the effects of HAART by more
effectively lowering plasma and genital HIV viral load. This study will determine whether
HSV-2 treatment with acyclovir is effective in controlling HIV plasma viral load and
cervical shedding of HIV in women starting on HAART as per Peruvian guidelines.
This study will last 24 weeks. Participants will be randomly assigned into one of two
groups. Group 1 participants will receive twice-daily 800 mg of acyclovir for 24 weeks.
Group 2 participants will receive twice-daily placebo for 24 weeks. Both groups will receive
HAART from the Peruvian Ministry of Health. There will be 15 visits during this study.
Medical history; a physical exam; blood collection; family planning counseling; and
cervical, vaginal, and vulvar swab collection will begin prior to study entry and will occur
at all study visits.
Minimum age: 18 Years.
Maximum age: N/A.
- HIV-1 infected
- HSV-2 infected
- Initiating HAART per Peruvian guidelines for the first time at study entry
- CD4 count less than 200 cells/mm3 OR CD4 count less than 350 cells/mm3 AND viral load
greater than 55,000 copies/ml within 30 days prior to study entry
- Does not intend to move outside of greater metropolitan Lima, Peru area for the
duration of the study
- Willing to follow all study requirements
- Willing to provide written informed consent
- Prior HAART
- History of adverse reaction to acyclovir, famciclovir, or valacyclovir
- Unwilling to take acyclovir, famciclovir, or valacyclovir
- History of seizures
- Renal insufficiency, defined as serum creatinine greater than 2 mg/dl or a creatinine
clearance less than 50 ml/min
- Treatment for a serious medical condition 14 days prior to study entry. Patients with
chronic, acute, or recurrent opportunistic infections (OIs) who have completed
therapy and are clinically stable on therapy for at least 14 days prior to study
entry are not excluded.
- Clinically unstable and untreated OIs or tumors within 14 days prior to study entry.
More information on this criterion can be found in the protocol.
- Clinically unstable and untreated bacterial sexually transmitted diseases (STDs)
within 14 days prior to study entry. More information on this criterion can be found
in the protocol.
- Radiation therapy or systemic chemotherapy within 45 days prior to study entry.
Participants who underwent systemic chemotherapy for the treatment of Kaposi's
sarcoma (KS) if it was completed prior to study entry are not excluded.
- Any immunomodulator, HIV vaccine, or other investigational therapy within 30 days
prior to study entry. Patients who received a tapering course of corticosteroids as
acute therapy for Pneumocystis carinii pneumonia (PCP) or are receiving inhaled or
nasal fluticasone are not excluded.
- Current drug or alcohol use that, in the investigator's opinion, may interfere with
- Vomiting or inability to swallow medications
- Involuntarily incarcerated in a correctional facility, prison, or jail or being
detained for the treatment of either a psychiatric or infectious disease
- Grade 2 or 3 high-grade cervical dysplasia and cervical neoplasia within 6 months
prior to study entry
- Any other condition that, in the investigator's opinion, may interfere with the study
Locations and Contacts
IMPACTA - San Miguel CIPRA Project 1 CRS, San Miguel, Lima 32, Peru
Click here for more information about acyclovir
Haga clic aquí para ver información sobre este ensayo clínico en español.
Posavad CM, Wald A, Kuntz S, Huang ML, Selke S, Krantz E, Corey L. Frequent reactivation of herpes simplex virus among HIV-1-infected patients treated with highly active antiretroviral therapy. J Infect Dis. 2004 Aug 15;190(4):693-6. Epub 2004 Jul 13.
Wright PW, Hoesley CJ, Squires KE, Croom-Rivers A, Weiss HL, Gnann JW Jr. A prospective study of genital herpes simplex virus type 2 infection in human immunodeficiency virus type 1 (HIV-1)-seropositive women: correlations with CD4 cell count and plasma HIV-1 RNA level. Clin Infect Dis. 2003 Jan 15;36(2):207-11. Epub 2003 Jan 6.
Schacker T, Zeh J, Hu H, Shaughnessy M, Corey L. Changes in plasma human immunodeficiency virus type 1 RNA associated with herpes simplex virus reactivation and suppression. J Infect Dis. 2002 Dec 15;186(12):1718-25. Epub 2002 Nov 22.
Starting date: September 2006
Last updated: September 20, 2013