Trial reportAIDS (London, England)2009
Impact of aciclovir on genital and plasma HIV-1 RNA in HSV-2/HIV-1 co-infected women: a randomized placebo-controlled trial in South Africa.
Trial report in AIDS (London, England), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 62 papers, 10 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
62 citing papers in PubMed, 10 syntheses or guidelines pooled it, 96 citations in OpenAlex.
- 2024 European guidelines for the management of genital herpes.Journal of the European Academy of Dermatology and Venereology : JEADV · 2025Guideline
- British Association of Sexual Health and HIV UK national guideline for the management of anogenital herpes, 2024.International journal of STD & AIDS · 2025Guideline
- Interventions for men and women with their first episode of genital herpes.The Cochrane database of systematic reviews · 2016Pooled it
- Integrating prevention interventions for people living with HIV into care and treatment programs: a systematic review of the evidence.Journal of acquired immune deficiency syndromes (1999) · 2015Pooled it
- Genital herpes: oral antiviral treatments.BMJ clinical evidence · 2015Pooled it
- Genital ulcer disease treatment for reducing sexual acquisition of HIV.The Cochrane database of systematic reviews · 2012Pooled it
- The role of coinfections in HIV epidemic trajectory and positive prevention: a systematic review and meta-analysis.AIDS (London, England) · 2011Pooled it
- Meta-analysis of randomized trials on the association of prophylactic acyclovir and HIV-1 viral load in individuals coinfected with herpes simplex virus-2.AIDS (London, England) · 2011Pooled it
- Genital herpes.BMJ clinical evidence · 2011Pooled it
- Weighing the gold in the gold standard: challenges in HIV prevention research.AIDS (London, England) · 2010Pooled it
- Valacyclovir Decreases Plasma HIV-1 RNA in HSV-2 Seronegative Individuals: A Randomized Placebo-Controlled Crossover Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2015Trial
- High-dose valacyclovir decreases plasma HIV-1 RNA more than standard-dose acyclovir in persons coinfected with HIV-1 and HSV-2: a randomized crossover trial.Journal of acquired immune deficiency syndromes (1999) · 2013Trial
- Correlation between pill counts and biologic effects in an HIV-1 prevention clinical trial: implications for measuring adherence.AIDS and behavior · 2013Trial
- Valacyclovir suppressive therapy reduces plasma and breast milk HIV-1 RNA levels during pregnancy and postpartum: a randomized trial.The Journal of infectious diseases · 2012Trial
- Effect of HSV-2 suppressive therapy on genital tract HIV-1 RNA shedding among women on HAART: a pilot randomized controlled trial.Infectious diseases in obstetrics and gynecology · 2012Trial
- Effects of valacyclovir on markers of disease progression in postpartum women co-infected with HIV-1 and herpes simplex virus-2.PloS one · 2012Trial
- High-dose valacyclovir HSV-2 suppression results in greater reduction in plasma HIV-1 levels compared with standard dose acyclovir among HIV-1/HSV-2 coinfected persons: a randomized, crossover trial.The Journal of infectious diseases · 2011Trial
- Episodic therapy for genital herpes in sub-saharan Africa: a pooled analysis from three randomized controlled trials.PloS one · 2011Trial
- Estimating the impact of plasma HIV-1 RNA reductions on heterosexual HIV-1 transmission risk.PloS one · 2010Trial
- Long-term impact of acyclovir suppressive therapy on genital and plasma HIV RNA in Tanzanian women: a randomized controlled trial.The Journal of infectious diseases · 2010Trial
2 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
Authors and funding
10 authors at 3 institutions in 4 countries.
Funding
Abstract
backgroundSeveral studies suggest that herpes simplex virus type 2 (HSV-2) may enhance HIV-1 transmission and disease progression.
methodsWe conducted a randomized, double-blind, placebo-controlled trial of aciclovir 400 mg twice daily for 3 months in 300 HSV-2/HIV-1 co-infected women not yet on highly active antiretroviral therapy (HAART). Participants were evaluated prerandomization and at monthly visits for 3 months. Primary outcomes were the detection and quantity of genital HIV-1 RNA at the month 3 (M3) visit. Analyses were also undertaken using data from all visits. The treatment effects on plasma HIV-1 RNA, CD4 cell count and genital HSV-2 DNA were also assessed.
resultsAt M3 fewer women had detectable genital HIV in the aciclovir group compared to placebo, but this was not significant [61/132 (46%) vs. 71/137 (52%), risk ratio (RR) 0.89, 95% confidence interval (CI) 0.70-1.14; P = 0.36]. There was also little difference in quantity of HIV-1 RNA among shedders (+0.13 log10 copies/ml, 95% CI -0.14 to 0.39) at M3. However, aciclovir significantly decreased the frequency of HIV-1 shedding over all visits [adjusted odds ratio (OR) 0.57, 95% CI 0.36-0.89]. Significant reductions in M3 plasma HIV-1 RNA (-0.34 log10 copies/ml, 95% CI 0.15-0.54), genital HSV-2 DNA (8 vs. 20%, RR 0.37, 95% CI 0.19-0.73) and genital ulceration (8 vs. 18%, RR 0.43, 95% CI 0.22-0.84) were observed in the aciclovir group.
conclusionHSV-2 suppressive therapy, by reducing HIV-1 plasma viral load and altering the pattern of genital HIV-1 shedding, may contribute to the reduction in sexual transmission of HIV-1 and may delay the requirement for HAART initiation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.