Efficacy of Valacyclovir and Acyclovir for Suppression of HSV Evaluated
The efficacy of valacyclovir and acyclovir on genital herpes simplex virus (HSV) shedding was assessed in a double-blind, three-period crossover trial involving 69 HSV infected patients. Patients were assigned to one of three groups; 400 mg oral acyclovir twice daily, 500 mg oral valacyclovir twice daily, or placebo twice daily. After seven weeks of initial treatment, each participant crossed over to the second treatment for seven weeks, and then to the third treatment for the final seven weeks. It was found that both valacyclovir and acyclovir were associated with lower HSV shedding, both in quantity and frequency, as measured by PCR and culture, compared to the placebo. Total suppression of HSV viral replication was not achieved in either of the treatment groups.Anna Wald, Rachna Gupta, Elizabeth Krantz, et al.
Michigan Prisons Get $1.2M to Test for HCV
Governor Jennifer Granholm recently signed legislation giving $1.2 million for a new HCV testing and treatment program for Michigan prisoners. This is the state's first step in a plan to fight the spread of HCV inside its 42 prisons. Granholm proposed the program earlier this year after a State Journal
report in September 2003 found up to 18,000 of 48,000 Michigan inmates harbor HCV.NATAP (www.natap.org)
Long-Term Outcome Looks Good
Data was obtained for 343 patients with chronic HCV and then evaluated for sustained virological response (SVR), defined as no detectable HCV-RNA in serum at six months of treatment. Of 343 patients treated for chronic hepatitis C, 286 patients had a SVR. Among the patients with a SVR, the rate of decompensated liver cirrhosis and HCC was 1.0% and 0%, respectively. The standard mortality rate was 1.4 and there was no statistically significant difference in mortality between sustained virologic responders and the general population, matched for age and sex. Combination therapy leads to higher sustained virologic response rates than does monotherapy. In patients who had been treated with interferon monotherapy, the late relapse rate was 4.7%. In patients who were treated with both interferon and ribavirin, after four years of follow-up, the late virologic relapse rate was 3% and 1%, for patients treated for 24 and 48 weeks, respectively. After treatment with pegylated interferon with or without ribavirin, after 4 years of follow-up, a late relapse rate of 0.8% was reported.
Gut. October, 2004.
Solid-Organ Transplant in HIV-Infected Patients
Traditionally, HIV-infected patients are often not considered for solid-organ transplants, including liver and kidney. However, improvements in antiretroviral therapy, opportunistic infection prophylaxis, and treatment to prevent rejection have made solid-organ transplant a possibility for HIV-infected patients. In one study, 26 and 19 patients received kidney and liver transplants, respectively. At a median follow-up of 314 days, two of the 26 patients who received kidney transplants died, while four of 19 patients who received liver transplants died. Death from opportunistic infections occurred in one of the kidney recipients and one of the liver recipients. At follow-up CD4+ cell counts were maintained and HIV RNA levels remained largely suppressed. This study indicates that in carefully selected patients, baseline immunologic and virologic values can be maintained, and opportunistic infection complications are often infrequent.www.iasusa.org
HIV/AIDS in Women on the Rise
In 1992, women accounted for 14% of all AIDS cases in the United States. However, by 1999, women accounted for more than 20% of all AIDS cases. The epidemic has increased principally in African American and Hispanic women, with these two groups accounting for 81% of all AIDS cases reported to date among United States women. African American women and Hispanic women account for 67% and 14% of all AIDS cases in women, respectively. Of women living with AIDS, the two main reported transmission routes for HIV infection are heterosexual exposure (38%) or injection drug use (25%). Additionally, women aged 35-44 years were most likely to have contracted HIV through injection drug use, while women aged 20-24 were most likely to have contracted HIV through heterosexual exposure. States with the highest prevalence of AIDS cases in women include Florida, Georgia, South Carolina, Maryland, Delaware, New Jersey, New York, and Connecticut.NATAP (www.natap.org)
HCV Clearance Examined in Injection Drug Users (IDUs)
A retrospective cohort of IDUs with HCV infection was established to examine spontaneous viral clearance, defined as two consecutive negative HCV RNA test results after infection. Estimates of viral clearance at six, 12, and 24 months were 27%, 42%, and 45%, respectively, for IDUs who experienced HCV antibody seroconversion between 1992-1996, compared with 19%, 34%, and 34%, respectively, for IDUs who experienced seroconversion between 1997-2002. Most cases of viral clearance occurred within the initial 12 months after the estimated time of infection, but spontaneous viral clearance did extend to as late as 24 months.Marianne Jauncey, Joanne Micallef, Stuart Gilmour, et al.
JID, October 2004.
Back to the IDCR December 2004 contents page.