Transient Increase in HSV-2-Associated Genital Ulcers Following Initiation of Antiretroviral Therapy in HIV-1/HSV-2 Co-Infected Individuals.

Publication Type:

Journal Article


The Journal of infectious diseases (2015)


BACKGROUND:  Immune reconstitution inflammatory syndrome (IRIS) in HIV-infected persons beginning antiretroviral therapy (ART) has been incompletely characterized for herpes simplex virus 2 (HSV-2).

METHODS:  We evaluated genital ulcer disease (GUD) and HSV-2 associated GUD at quarterly visits or when spontaneously reported at monthly visits in 3381 HIV-1/HSV-2 co-infected individuals in a placebo-controlled trial of suppressive acyclovir therapy to prevent HIV transmission, 349 of whom initiated ART during the study. Incidence was calculated for months before and after ART initiation and incidence rate ratios (IRR) were calculated.

RESULTS:  GUD incidence increased from 15.0 episodes per 100 person-years before ART to 26.9 episodes (IRR 1.83, p=0.03) in the first full quarter after ART initiation and HSV-2 GUD increased from 8.1 to 19.0 episodes (IRR 2.20, p=0.02). Subsequently, the incidence of GUD was similar to that before ART, although the numbers were small. Persons receiving suppressive acyclovir had fewer GUD episodes, but the IRR after beginning ART was similar to the placebo group.

CONCLUSIONS:  Initiation of ART in HIV-1/HSV-2 co-infected persons is associated with a transient increase in GUD and HSV-2 GUD. Acyclovir reduces the incidence of GUD, but not the increase in GUD incidence in the quarter following initiation of ART.