The association between genital herpes and higher viral loads of HIV-1 in HIV-infected persons is strong enough to warrant more routine testing for the herpes virus in HIV-positive patients, as well as additional clinical studies of the co-infections, according to an editorial to be published in the Feb. 22 New England Journal of Medicine.
"The clinical management of herpes simplex virus type 2 (HSV-2) in patients with HIV infection has lagged seriously behind the large body of medical literature on the importance of the interaction between these two pathogens," writes Larry Corey, M.D., principal investigator of the HIV Vaccine Trials Network at Fred Hutchinson Cancer Research Center, and head of the Infectious Diseases Program and Virology Division at the University of Washington School of Medicine. Corey's commentary relates to the paper by Nicolas Nagot, M.D., and colleagues in the same issue of the journal,
"Reduction of HIV-1 RNA levels with therapy to suppress herpes simplex virus." Researchers found that treating HSV-2 infections reduces genital and systemic levels of HIV-1 RNA. Repeated studies have shown that HSV-2 increases the amount of HIV-1 in plasma and genital secretions. The research group led by Corey at the Hutchinson Center was the first to note the association between HSV-2 and HIV in studies done in Seattle in 1988. The Nagot paper builds upon the initial work the group did by showing that daily antiviral therapy to treat HSV-2 infection can reduce the replication rate of HIV-1.
"The demonstration that daily anti-HSV-2 therapy can reduce the viral load by this amount is thus of direct importance for treatment," Corey wrote. Corey urges clinicians to incorporate more routine testing for HSV-2 into the initial evaluation of HIV-positive patients. The Nagot paper "has direct clinical implications, suggesting that HIV-1 replication can be reduced with antiviral therapy directed solely at HSV-2," wrote Corey. Most people worldwide with sexually-acquired HIV have active HSV-2 infections: 30 percent to 70 percent in Europe and 50 percent to 90 percent in Africa, according to an earlier study by Corey.
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