A Tale of Two Viruses: HSV-2 and HIV

Herpes simplex virus (HSV)-2 coinfection is associated with increased genital HIV shedding, which may increase transmissibility of HIV. Might suppressing HSV reactivation with antiviral therapy reduce genital HIV shedding? To address this question, investigators randomized 140 HIV/HSV-2–seropositive women in Burkina Faso to receive 12 weeks of either valacyclovir (500 mg twice daily) or placebo. The women were ineligible for potent antiretroviral therapy according to WHO recommendations for resource-scarce countries, mainly because of high CD4 counts (median, 446 cells/mm³).

During the 12 weeks before randomization, genital and plasma HIV RNA levels were higher in women with detectable genital HSV-2 than in those who never shed HSV-2. As exp…