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Herpes simplex virus (HSV)-2 coinfection is associated with increased plasma and genital-tract HIV RNA levels and may increase the risk for HIV transmission. Many experts have believed that suppressing HSV-2 reactivation might reduce the likelihood of HIV transmission. To assess this possibility, investigators studied heterosexual couples in which one partner was HIV uninfected and the other was both HIV and HSV-2 seropositive — with CD4 counts ≥250 cells/mm3 and no current antiretroviral therapy (ART). The infected partners were randomized to receive oral acyclovir or placebo for up to 24 months.
A total of 3408 couples in southern and East Africa were enrolled. HIV seroconversion occurred in 132 initially uninfected partners. HIV sequencin…