ACV и valACV хорошо уменьшают вирусную нагрузку
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21.03.2015
Лечение валацикловиром (пролекарством ацикловира) генитального герпеса HSV-2 у ВИЧ-инфицированных пациентов заметно снижает концентрацию РНК ВИЧ в плазме крови.
Клинические исследования проводились на протяжении полугода в США и Перу. Кроме больных герпесом, для участия в эксперименте привлекли ещё 18 пациентов с ВИЧ-1, но серонегативных к HSV-2, то есть генитальным герпесом не инфицированных.
Результаты клинических исследований опубликованы в журнале Clinical Infectious Diseases. Главный вывод - препарат можно безопасно использовать больным с ВИЧ-инфекцией, у которых высокая устойчивость к другим антиретровирусным препаратам. Валацикловир хорошо переносится и не имеет побочных эффектов.
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Valacyclovir Decreases Plasma HIV-1 RNA in HSV-2 Seronegative Individuals: A Randomized Placebo-Controlled Crossover Trial | http://cid.oxfordjournals.org/content/early/2015/03/03/cid.civ172.abstract |
Background. Acyclovir (ACV), a highly specific anti-herpetic drug, acts as a DNA chain terminator for several human herpesviruses (HHVs), including HHV-2 (HSV-2), a common HIV-1 co-pathogen. Several trials demonstrated that HSV-2 suppressive therapy using ACV or its prodrug valacyclovir (valACV) reduced plasma HIV-1 viral load (VL) in HIV-1/HSV-2 coinfected persons, and this was proposed to be due to a decrease in generalized immune activation. Recently, however, we found that ACV directly suppresses HIV-1 ex vivo in tissues free of HSV-2 but endogenously coinfected with other HHVs. Here, we asked whether valACV suppresses VL in HIV-1 infected HSV-2-seronegative persons.
Methods. 18 HIV-1 infected HSV-2-seronegative individuals were randomly assigned in a double blind placebo-controlled, crossover trial. Eligible participants had CD4 cell counts of ≥500 cells/μL and were not taking antiretroviral therapy. Subjects in group A received 12 weeks of valACV 500 mg given twice daily by mouth followed by two weeks of a no treatment washout and then 12 weeks of placebo; subjects in group B received 12 weeks of placebo followed by 2 weeks of no treatment washout and then 12 weeks of valACV 500 mg twice daily.
Results. HIV-1 VL in plasma of patients treated with valACV 500 mg twice daily for 12 weeks was reduced on average by 0.37 log10 copies/mL.
Conclusions. These data indicate that the effects of valACV on HIV-1 replication are not related to the suppression of HSV-2-mediated inflammation and are consistent with a direct effect of ACV on HIV-1 replication.
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