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HAART shortens manifestation of herpes simplex in HIV patients
  By Will Boggs, MD
NEW YORK (Reuters Health) - HIV treatment is associated with fewer days of herpes simplex virus (HSV) lesions, although mucosal shedding and HSV DNA levels do not differ between treated and untreated patients, according to a report in the August 15th issue of The Journal of Infectious Diseases.
Virtually all HIV-infected patients are HSV-1-positive, and most are seropositive for HSV-2, the authors point out. Whether highly active antiretroviral therapy (HAART) affects mucosal HSV reactivation and disease is unknown.
Dr. Christine M. Posavad and colleagues from University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington evaluated whether HAART reconstituted the host immune response to HSV in 77 HIV-infected, HSV-2-seropositive patients and whether these alterations were associated with an effect on mucosal HSV reactivation and disease.
Median CD4 counts were similar for the 28 HAART-treated and 49 untreated patients, the authors report, but the median HIV RNA level was significantly higher for the untreated group (18,793 copies/mL) than for the HAART-treated group (170 copies/mL).
The frequency of HSV shedding and the amount of HSV DNA shed from mucosal and genital sites were similar for HAART-treated and untreated HIV-infected subjects. In contrast, HAART-treated patients had fewer median days with HSV lesions (2.8% of total days) than did untreated patients (11.3% of total days).
Nevertheless, Dr. Posavad told Reuters Health that "patients with HIV who are on HAART still have frequent HSV-2 reactivation." Should type-specific serology reveal such an infection, "they should consider whether they are best off trying daily antiviral therapy."
J Infect Dis 2004;190:693-696.


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