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Transient Increase in Herpes Simplex Virus Type 2 (HSV-2)–Associated Genital Ulcers Following Initiation of Antiretroviral Therapy in HIV/HSV-2–Coinfected Individuals

Authors :
Fife, Kenneth H.
Mugwanya, Kenneth
Thomas, Katherine K.
Baeten, Jared M.
Celum, Connie
Bukusi, Elizabeth
de Bruyn, Guy
Mujugira, Andrew
Vwalika, Bellington
Wald, Anna
Lingappa, Jairam R.
Lingappa, Jairam
Campbell, Mary
Corey, Lawrence
Coombs, Robert W.
Hughes, James P.
Magaret, Amalia
McElrath, M. Juliana
Morrow, Rhoda
Mullins, James I.
Coetzee, David
Fife, Kenneth
Were, Edwin
Essex, Max
Makhema, Joseph
Katabira, Elly
Ronald, Allan
Allen, Susan
Kayitenkore, Kayitesi
Karita, Etienne
Cohen, Craig
Kanweka, William
Kapiga, Saidi
Manongi, Rachel
Farquhar, Carey
John-Stewart, Grace
Kiarie, James
Inambao, Mubiana
Delany-Moretlwe, Sinead
Rees, Helen
Gray, Glenda
McIntyre, James
Mugo, Nelly Rwamba
Publication Year :
2015
Publisher :
Oxford University Press, 2015.

Abstract

BACKGROUND Immune reconstitution inflammatory syndrome (IRIS) in human immunodeficiency virus (HIV)-infected persons beginning antiretroviral therapy (ART) has been incompletely characterized for herpes simplex virus type 2 (HSV-2). METHODS We evaluated genital ulcer disease (GUD) and HSV-2-associated GUD at quarterly visits or when spontaneously reported at monthly visits in 3381 HIV/HSV-2-coinfected individuals in a placebo-controlled trial of suppressive acyclovir therapy to prevent HIV transmission, 349 of whom initiated ART during the study. Incidence was calculated for months before and after ART initiation, and incidence rate ratios (IRRs) were calculated. RESULTS GUD incidence increased from 15.0 episodes per 100 person-years before ART to 26.9 episodes per 100 person-years in the first full quarter after ART initiation (IRR, 1.83;P= .03), and the incidence of HSV-2-associated GUD increased from 8.1 to 19.0 episodes per 100 person-years (IRR, 2.20;P= .02). Subsequently, the incidence of GUD was similar to that before ART, although the numbers were small. Persons receiving suppressive acyclovir had fewer GUD episodes, but the IRR after beginning ART was similar in the acyclovir and placebo groups. CONCLUSIONS Initiation of ART in HIV/HSV-2-coinfected persons is associated with a transient increase in GUD and HSV-2 GUD. Acyclovir reduces the incidence of GUD but does not prevent an increase in GUD incidence during the first quarter following initiation of ART.

Details

Language :
English
Database :
OpenAIRE
Accession number :
edsair.doi.dedup.....4e9d5045bf5c93400ca13a676a048b73