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HIV-1 and Herpes Simplex Virus-2—A Dastardly Duo
during the course of the study, which probably accounts for at least some of spread of drug-resistant strains of HSV. Currently, 5–6% of HIV-positive
the observed impact of valacyclovir. Clinical trials are currently evaluating individuals are infected with acyclovir-resistant HSV-2 strains compared
whether acyclovir treatment can reduce HIV acquisition in HSV-2-infected with fewer than 1% of immunocompetent subjects.
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However, to date
individuals or slow HIV disease progression in dually infected patients. the widespread use of acyclovir and other nucleoside analog drugs that
target HSV-2 has not increased the rate of HSV-drug-resistance in either
Conclusions the immunocompetent or the immunocompromised populations.
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HSV-2 infection increases the risk of HIV acquisition approximately
three-fold. Within co-infected patients, HSV-2 increases the plasma load of While the use of existing HSV therapies holds great promise, the discovery
HIV, which may enhance HIV disease progression. In the dually infected of an effective HSV vaccine remains an even more important goal. An HSV
patient, HSV-2 is further correlated with an increased frequency and vaccine could protect against the increased risk for HIV acquisition by
quantity of genital HIV shedding. In this way, HSV-2 infection may also preventing initial infection with HSV-2. A vaccine could also prevent
increase the transmission rate of HIV. Anti-HSV-2 therapies offer an increased replication and shedding of HIV by avoiding dual infection with
important tool in the fight against HIV, and can reduce both the replication HIV and HSV-2. Many potential HSV-2 vaccine strategies are currently
and shedding of HIV. This observation suggests that such treatments may under evaluation, including subunit and live attenuated virus vaccine
decrease HIV disease progression as well as HIV transmission. candidates. However, until an effective HSV-2 vaccine becomes available,
suppressive HSV-2 therapy remains the most promising option for the
The long-term use of suppressive HSV therapy is both safe and effective. prevention of HSV-2-induced increases in HIV acquisition, replication,
However, there is concern that suppressive therapies may lead to the and transmission. ■
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