What is the role of acyclovir in the treatment of HIV infection?

Updated: Jul 27, 2020
  • Author: Shelley A Gilroy, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Most individuals infected with HIV-1 are also infected with herpes simplex virus type 2 (HSV-2). Suppressive therapy of HSV-2 with acyclovir reduces plasma HIV-1 concentrations. Lingappa et al found that acyclovir reduced risk for HIV-1 disease progression by 16% compared with placebo. [138] Disease progression was defined as first occurrence of CD4+ T-cell counts dropping below 200/μL.

In this study, patients (n=3381) who were dually infected with HSV-2 and HIV-1, had CD4+ cell counts of at least 250/μL, and were not taking antiretroviral therapy were randomized to receive either acyclovir 400 mg PO orally twice daily or placebo. In patients with CD4+ counts of 350/μL or more, acyclovir delayed risk of CD4+ counts falling below 350/μL by 19%. The use of acyclovir to suppress HSV-2 before initiating antiretroviral therapy merits further study to determine its effects on HIV-1 disease progression.

A second study of 440 people in Uganda showed that, in those with HIV and HSV-2 as well as HIV viral loads above 50,000/mL, there was a significant delay in the progression to AIDS-defining illnesses or CD4 T-cell decline in the acyclovir group compared to placebo. Interestingly, no significant benefit was found for those with viral loads below 50,000/mL. [139]

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