HSV-2 Suppression to Reduce HIV-1 Levels in HIV-1, HSV-2 Co-infected Men.

HIV Infection Clinical Trial

Official title:

A Randomized, Double-blind, Placebo-controlled Crossover Trial of Valacyclovir for Suppression of HSV and HIV Shedding in HIV-1, HSV-2 Coinfected Men Who Have Sex With Men (MSM).

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00378976
• Other study ID #: 21760-A
• Secondary ID: AI277S7;AI38858
• Status: Completed
• Phase: Phase 3
• First received: September 19, 2006
• Last updated: August 21, 2013
• Start date: August 2003
• Est. completion date: July 2004

Study information

• Verified date: August 2013
• Source: University of Washington
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Institutional Review Board
• Study type: Interventional

Clinical Trial Summary

Over 80% of HIV-1 infected persons are also seropositive for HSV-2. Increasingly, clinical and epidemiologic evidence show the role of HSV in increasing HIV infectiousness. The evidence suggests that that HSV is an important cofactor in HIV transmission.

The trial's purpose is to assess the reduction in HIV shedding associated with valacyclovir for suppression of HSV-2 reactivation.

This proof-of-concept, randomized, double-blind, placebo controlled crossover trial of 20 HIV/HSV-2 co-infected men, assessed the effects of daily valacyclovir on HIV-1 levels in the plasma and rectal mucosa secretions.

Description:

Herpes simplex virus type 2 (HSV-2) is common among HIV infected persons. HSV-2 reactivation is associated with increased plasma and genital HIV-1 levels, and in vitro, HSV-2 upregulates HIV transcription.

The trial assessed whether HSV-2 suppression reduces rectal and plasma HIV-1 levels in HIV-1, HSV-2 co-infected men who have sex with men (MSM).

Conducted in Lima Peru, 20 antiretroviral naive HIV-1 and HSV-2 seropositive MSM with CD4 >200 were randomly assigned to receive valacyclovir 500 mg bid or placebo for 8 weeks, than a 2 week washout period, followed by the alternative regimen for 8 weeks. Men collected daily home anogenital swabs for HSV DNA PCR, had three weekly anoscopy procedures for collection of rectal mucosal secretions for HIV-1 RNA, HSV DNA, and weekly plasma HIV-1 RNA by PCR. Outcomes were plasma and rectal HIV-1 levels by study arm.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 20
• Est. completion date: July 2004
• Accepts healthy volunteers: No
• Gender: Male
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Greater than 18 years old,

• Documented HIV-1 seropositive,

• CD4 count greater than 200,

• Not on HIV antiretroviral therapy,

• HSV-2 seropositive as determined by Focus EIA (IN >3.5)

• Not intending to move out of the area for the duration of study participation.

• Willing and able to:provide independent written informed consent;undergo clinical evaluations;take study drug as directed;adhere to follow-up schedule.

• Bacterial STDs (symptomatic STD syndromes or laboratory-confirmed asymptomatic gonorrhea and syphilis) are treated within two weeks of study enrollment and random assignment.

Exclusion Criteria:

MSM who meet any of the following criteria are not eligible for this study:

• Known history of adverse reaction to valacyclovir, acyclovir or famciclovir;

• Planned open label use of acyclovir, valacyclovir, or famciclovir

• Known medical history of seizures

• Known renal failure, serum creatinine >2.0mg/dl

• Hematocrit < 30 %

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Crossover Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Prevention

Related Conditions & MeSH terms

• Herpes Simplex
• HIV Infection
• HIV Infections
• Sexually Transmitted Diseases

Intervention

Drug:
• valacyclovir
500 mg twice-daily oral
• matching placebo
twice daily as per experimental drug

Locations

Country	Name	City	State
Peru	Asociacion Civil Impacta Salud y Educacion	Lima

Sponsors (3)

Lead Sponsor	Collaborator
University of Washington	Asociación Civil Impacta Salud y Educación, Peru, GlaxoSmithKline

Country where clinical trial is conducted

Peru, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Reduction in anogenital HIV-1 shedding with suppression of HSV-2 reactivation.		18 weeks	No
Secondary	Evaluate HSV-2 suppression with decreased plasma HIV RNA levels		18 weeks	No
Secondary	Assess the effect of daily valacyclovir on pharyngeal shedding in HSV-1 seropositive individuals		18 weeks	No
Secondary	Determine the temporal pattern of HIV shedding in the rectum, pharynx and semen with respect to mucosal HSV-1 and HSV-2 reactivation; Determine HSV-2 suppression and HIV replication within rectal mucosa.		18 weeks	No