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Tan DHS, Raboud JM, Szadkowski L, Grinsztejn B, Madruga JV, Figueroa MI, Cahn P, Barton SE, Clarke A, Fox J, Zubyk W, Walmsley SL. Effect of valaciclovir on CD4 count decline in untreated HIV: an international randomized controlled trial. J Antimicrob Chemother 2020; 74:480-488. [PMID: 30376108 PMCID: PMC6337901 DOI: 10.1093/jac/dky433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/26/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To determine the impact of valaciclovir on HIV disease progression in treatment-naive HIV-positive adults. Methods In this fully blind, multicentre, 1:1 randomized placebo-controlled trial, treatment-naive HIV-1-positive adults with CD4 counts 400–900 cells/mm3 and not meeting contemporaneous recommendations for combination ART (cART) were randomized to valaciclovir 500 mg or placebo twice daily, and followed quarterly until having two consecutive CD4 counts ≤350 cells/mm3 or initiating cART for any reason. The primary analysis compared the rate of CD4 count decline by study arm after adjusting for baseline CD4 count and viral load (VL). Secondary analyses compared the rate of CD4 percentage decline, HIV VL, herpes simplex virus (HSV) recurrences and drug-related adverse events. The trial closed after release of the START trial results in August 2015. Results We enrolled 198 participants in Canada, Brazil, Argentina and the UK. Median (IQR) age was 35 (30–43) years. Baseline CD4 count was 592 (491–694) cells/mm3 and VL was 4.04 (3.5–4.5) log10 copies/mL. Over 276 person-years of follow-up, CD4 counts declined by 49 cells/mm3/year in the valaciclovir arm versus 58 cells/mm3/year in the placebo arm (P = 0.65). No differences were seen in the rate of change in CD4 percentage (−1.2%/year versus −1.7%/year, P = 0.34). VL was 0.27 log10 copies/mL lower in valaciclovir participants overall (P<0.001). Placebo participants had more HSV recurrences (62 versus 21/100 person-years, P < 0.0001) but similar rates of grade ≥2 drug-related adverse events. Conclusions Unlike prior trials using aciclovir, we found that valaciclovir did not slow CD4 count decline in cART-untreated adults, although power was limited due to premature study discontinuation. Valaciclovir modestly lowered HIV VL.
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Affiliation(s)
- Darrell H S Tan
- Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Division of Infectious Diseases, University Health Network, Toronto, Canada
| | - Janet M Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Toronto General Research Institute, Toronto, Canada
| | - Leah Szadkowski
- Biostatistics Research Unit, University Health Network, Toronto, Canada
| | - Beatriz Grinsztejn
- Instituto de Pesquisa Clínica Evandro Chagas (IPEC), Fundaçao Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | - Pedro Cahn
- Fundación Huesped, Buenos Aires, Argentina
| | | | - Amanda Clarke
- Brighton & Sussex University Hospital NHS Trust, Brighton, UK
| | - Julie Fox
- Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Wendy Zubyk
- CIHR Canadian HIV Trials Network, Vancouver, Canada
| | - Sharon L Walmsley
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Infectious Diseases, University Health Network, Toronto, Canada.,Toronto General Research Institute, Toronto, Canada.,CIHR Canadian HIV Trials Network, Vancouver, Canada
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Ghosh I, Paul B, Das N, Bandyopadhyay D, Chakrabarti MK. Etiology of Vaginal/Cervical Discharge Syndrome: Analysis of Data from a Referral Laboratory in Eastern India. Indian J Dermatol 2018; 63:484-489. [PMID: 30504977 PMCID: PMC6233047 DOI: 10.4103/ijd.ijd_296_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Sexually transmitted infections (STIs) and reproductive tract infections (RTIs) constitute important public health problem worldwide. Syndromic diagnosis of vaginal/cervical discharge (VCD) is often inaccurate leading to over- or under-treatment. Aims This study aimed to ascertain the laboratory-confirmed diagnosis of VCD and their relative frequency in a group of patients presenting to a STI clinic in eastern India and to determine the sensitivity and specificity of clinical diagnosis. Settings and Design This was a cross-sectional study. Materials and Methods Data of 5301 consecutive patients with VCD were analyzed for etiological diagnosis and the findings were compared with laboratory data of 3110 asymptomatic cases. Statistical Analysis Used Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of clinical diagnosis of vaginal discharge syndrome were obtained considering the results of the laboratory diagnosis as gold standard. The strength of agreement was computed using Kappa statistic. Results Of 5301 cases of VCD, 90.83% had STI/RTIs. The most prevalent infection was trichomoniasis (35.23%), followed by bacterial vaginosis (33.05%) and vulvovaginal candidiasis (19.67%). Sensitivity, specificity, PPV, and NPV of vaginal discharge as an indicator of STI/RTI were 85.5%, 99.0%, 99.3%, and 80%, respectively, with agreement of 90.49% and kappa value of 0.8, indicating "almost perfect" agreement. Many cases with VCD also suffered from other STIs such as herpes simplex virus-2, hepatitis B, human immunodeficiency syndrome, and syphilis and some asymptomatic cases suffered from one or more STIs. Conclusions All patients with VCD with high-risk behavior should preferably undergo laboratory evaluation of the VCD syndrome to avoid over- or under-treatment.
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Affiliation(s)
- Ishita Ghosh
- Department of VD Serology and Department of STD, Institute of Serology, Kolkata, West Bengal, India
| | - Bandhan Paul
- Department of VD Serology and Department of STD, Institute of Serology, Kolkata, West Bengal, India
| | - Nibedita Das
- Department of VD Serology and Department of STD, Institute of Serology, Kolkata, West Bengal, India
| | - Debabrata Bandyopadhyay
- Department of Dermatology, Venereology and Leprosy, Medical College, Kolkata, West Bengal, India
| | - Manas Kumar Chakrabarti
- Department of VD Serology and Department of STD, Institute of Serology, Kolkata, West Bengal, India
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Okonko IO, Cookey TI, Okerentugba PO, Frank-Peterside N. Serum HSV-1 and -2 IgM in pregnant women in Port Harcourt, Nigeria. J Immunoassay Immunochem 2015; 36:343-58. [PMID: 25188909 DOI: 10.1080/15321819.2014.952442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The present study was undertaken for the purpose of finding IgM antibodies against HSV-1 and 2 infections among pregnant women and also to evaluate correlation of Serum HSV-1 and 2 IgM in these pregnant women. A total of 180 pregnant women attending antenatal clinic at Braithwaite Memorial Specialist Hospital (BMSH) in Port Harcourt, Nigeria were consecutively recruited, after they had given consents to participate in the study. Serum of each sample was assayed for HSV-1&2 IgM antibody using a commercial ELISA. Five (2.8%) of the pregnant women were positive for IgM antibody against HSV-1&2. Marital status mainly correlated (χ(2) = 221.5, P < 0.05) with HSV-2 infection and HSV-1/HSV-2 co-infection. Age, educational level, occupation, and gestation were not consistently associated (P>0.05) with HSV-1/HSV-2 infection and co-infection. We also observed a high overall anti-HSV-1&2 IgM seronegativity of 97.2% among these pregnant women. Group-specific seronegativity was also high ranging from 93.3-100%. Although the age-groups significantly differed, none of their variables showed statistical association with the seronegativity. This represents the first analysis of HSV IgM antibody reported in Port Harcourt, Nigeria and has important public health implications, particularly for pregnant women. Consideration of this information would benefit physicians providing primary gynecological and obstetric care to this population of women.
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Affiliation(s)
- I O Okonko
- a Medical Microbiology Unit, Department of Microbiology , University of Port Harcourt , Port Harcourt , Nigeria
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Amudha VP, Rashetha, Sucilathangam G, Cinthujah B, Revathy C. Serological Profile of HSV-2 in STD Patients: Evaluation of Diagnostic Utility of HSV-2 IgM and IgG Detection. J Clin Diagn Res 2015; 8:DC16-9. [PMID: 25653947 DOI: 10.7860/jcdr/2014/10586.5314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/06/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The present study was undertaken to determine Herpes Simplex Virus-2 seroprevalence in sexually active adults aged 20-49 and to investigate the correlation with sociodemographic characteristics and to find its association with other sexually transmitted diseases especially HIV and also to assess the proportion of primary and reactivated HSV-2 cases. MATERIALS AND METHODS This prospective study was carried out for a period of six months in a tertiary care hospital. Serum samples were taken from 91 patients attending the out Patient clinic of the Department of Venereology. The serological testing for HSV-2 was performed on all the specimens by using Euroimmun anti-HSV2 (gG2) IgM ELISA and IgG ELISA. RESULTS Out of the 91 STD patients in the study group, 18 males (34.62%) and 14 females (36.84%) tested positive for HSV-2 antibodies. Seropositivity rate is 35.16%. More number of HSV-2 positive cases were seen among males, older age, rural residence, low socioeconomic status, single marital status, irregular condom usage during the sexual intercourses with new partners and with higher number of sexual partners during lifetime. HSV-2 IgM alone was positive in three cases, HSV-2 IgG alone was positive in 26 cases and three had a positive HSV-2 IgM and IgG result. Addition of IgM testing increased rate of detecting seroconversion, 31.87%, when only IgG ELISA was used, to 35.16 % patients when IgM test was added. In the study group four cases tested positive for VDRL, and one of them was a known positive case. Among the 55 HIV positive cases in the study group, HSV 2 was positive in 17 cases and among the 36 HIV negative cases HSV 2 was positive in 15 cases. (30.91% and 47.22%).Though the number of HIV cases were high, HSV 2 positivity among them was statistically not significant. CONCLUSION The purpose of screening for HSV-2 is not only to identify seropositivity, but to help seropositive people identify symptoms and protect themselves from acquiring HIV and to protect their partners and seronegative people from acquiring HSV-2 and/or HIV.
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Affiliation(s)
- V P Amudha
- Senior Assistant Professor, Department of Microbiology, Tirunelveli Medical College , Tirunelveli, Tamil Nadu, India
| | - Rashetha
- Student, Department of Microbiology, Tirunelveli Medical College , Tirunelveli, Tamil Nadu, India
| | - G Sucilathangam
- Senior Assistant Professor, Department of Microbiology, Tirunelveli Medical College , Tirunelveli, Tamil Nadu, India
| | - B Cinthujah
- Senior Assistant Professor, Department of Microbiology, Tirunelveli Medical College , Tirunelveli, Tamil Nadu, India
| | - C Revathy
- Professor and Head, Department of Microbiology, Tirunelveli Medical College , Tirunelveli, Tamil Nadu, India
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Lupi O. Prevalence and risk factors for herpes simplex infection among patients at high risk for HIV infection in Brazil. Int J Dermatol 2011; 50:709-13. [PMID: 21595666 DOI: 10.1111/j.1365-4632.2010.04863.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Herpes simplex infection is responsible for substantial morbidity in patients with HIV infection. Data from less-developed countries analyzing risk factors within this population are largely unavailable. AIMS Investigate the incidence and seroprevalence of HSV-1 and HSV-2 infection in populations at high and low risk for HIV infection. MATERIALS AND METHODS A prospective cohort study was performed in a population at high risk for STDs composed of 170 HIV seronegative male homosexuals and bisexuals (group A). The population at low risk for STDs was composed of 155 volunteer male blood donors (group B). All blood samples were screened using a type specific ELISA to HSV-1 and HSV-2 glycoprotein G (gG). RESULTS The prevalence of HSV-1 and HSV-2 infection among all the 325 patients was 83.5% and 63.4%, respectively. Annual incidence of HSV-1 and 2 among group A were 0.053% and 0.08%, respectively. Among group B, the incidence for HSV-1 was 0.04% and for HSV-2 was 0.02%. Educational parameters (P<0.001), irregular use of condoms (P<0.001), and percentage of previous receptive anal intercourse (P<0,012) were significantly associated with seropositivity to HSV-2. About 8.4% of the HSV-1 seronegative subjects presented recurrence episodes of herpes labialis as well as 7.6% of the HSV-2 seronegative patients had genital herpes in the past. DISCUSSION The high seroprevalence detected suggests that routine screening for HSV should be performed in populations at high risk for STDs, especially in HIV-infected patients. CONCLUSION Educational campaigns, with particular focus on the transmission of HSV, and the regular use of condoms are important measures to reduce the HSV dissemination among patients with less advanced educations and at high risk for STDs.
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Affiliation(s)
- Omar Lupi
- Dermatology Section, Universidade Federal doEstado do Rio de Janeiro and Policlínica Geral do rio de Janeiro, Rio de Janeiro, Brazil.
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Oncolytic herpes simplex virus 1 encoding 15-prostaglandin dehydrogenase mitigates immune suppression and reduces ectopic primary and metastatic breast cancer in mice. J Virol 2011; 85:7363-71. [PMID: 21543507 DOI: 10.1128/jvi.00098-11] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Oncolytic herpes simplex virus 1 (HSV-1) viruses armed with immunomodulatory transgenes have shown potential for enhanced antitumor therapy by overcoming tumor-based immune suppression and promoting antitumor effector cell development. Previously, we reported that the new oncolytic HSV-1 virus, OncSyn (OS), engineered to fuse tumor cells, prevented tumor growth and metastasis to distal organs in the 4T1/BALB/c immunocompetent breast cancer mouse model, suggesting the elicitation of antitumor immune responses (Israyelyan et al., Hum. Gen. Ther. 18:5, 2007, and Israyelyan et al., Virol. J. 5:68, 2008). The OSV virus was constructed by deleting the OS viral host shutoff gene (vhs; UL41) to further attenuate the virus and permit dendritic cell activation and antigen presentation. Subsequently, the OSVP virus was constructed by inserting into the OSV viral genome a murine 15-prostaglandin dehydrogenase (15-PGDH) expression cassette, designed to constitutively express 15-PGDH upon infection. 15-PGDH is a tumor suppressor protein and the primary enzyme responsible for the degradation of prostaglandin E2 (PGE2), which is known to promote tumor development. OSVP, OSV, and OS treatment of 4T1 tumors in BALB/c mice effectively reduced primary tumor growth and inhibited metastatic development of secondary tumors. OSVP was able to significantly inhibit the development and accumulation of 4T1 metastatic tumor cells in the lungs of treated mice. Ex vivo analysis of immune cells following treatment showed increased inflammatory cytokine production and the presence of mature dendritic cells for the OSVP, OSV, and OS viruses. A statistically significant decrease in splenic myeloid-derived suppressor cells (MDSC) was observed only for OSVP-treated mice. These results show that intratumoral oncolytic herpes is highly immunogenic and suggest that 15-PGDH expression by OSVP enhanced the antitumor immune response initiated by viral infection of primary tumor cells, leading to reduced development of pulmonary metastases. The availability of the OSVP genome as a bacterial artificial chromosome allows for the rapid insertion of additional immunomodulatory genes that could further assist in the induction of potent antitumor immune responses against primary and metastatic tumors.
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Tan DHS, Raboud JM, Kaul R, Grinsztejn B, Cahn P, Walmsley SL. Can herpes simplex virus type 2 suppression slow HIV disease progression: a study protocol for the VALacyclovir In Delaying Antiretroviral Treatment Entry (VALIDATE) trial. Trials 2010; 11:113. [PMID: 21106086 PMCID: PMC3002348 DOI: 10.1186/1745-6215-11-113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 11/24/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although highly active antiretroviral therapy (HAART) has dramatically decreased HIV-related morbidity and mortality, the associated costs, toxicities, and resistance risks make the potential delay of HAART initiation an attractive goal. Suppression of herpes simplex virus type 2 (HSV-2) may be a novel strategy for achieving this goal because HSV-2 is associated with clinically significant increases in HIV viral load, the primary driver of HIV disease progression. METHODS/DESIGN The VALacyclovir In Delaying Antiretroviral Treatment Entry (VALIDATE) trial is a multicentre, randomized, fully blinded, clinical trial of twice daily valacyclovir 500 mg versus placebo for delaying the need for initiating HAART among HIV-1, HSV-2 co-infected HAART-naïve adults. 480 participants from Canada, Brazil and Argentina will undergo quarterly clinical follow-up until reaching the composite primary endpoint of having a CD4+ T-cell count ≤ 350 cells/mm(3) or initiation of HAART for any reason, whichever occurs first. The primary analysis will use a proportional hazards model, stratified by site, to estimate the relative risk of progression to this endpoint associated with valacyclovir. Secondary analyses will compare the rates of change in CD4 count, median log10 HIV viral load, drug-related adverse events, frequency of HSV reactivations, rate of acyclovir-resistant HSV, and quality of life between study arms. DISCUSSION Although HIV treatment guidelines continue to evolve, with some authorities recommending earlier HAART among asymptomatic individuals, the potential delay of HAART remains a clinically relevant goal for many. If shown to be of benefit, implementation of the VALIDATE intervention will require careful consideration of both individual patient-level and public health implications. TRIAL REGISTRATION Current Controlled Trials ISRCTN66756285. ClinicalTrials.gov NCT00860977.
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Affiliation(s)
- Darrell HS Tan
- University Health Network, 585 University Ave., 13N - 1323, Toronto, Ontario, M5G 2N2 Canada
| | - Janet M Raboud
- University Health Network, 585 University Ave., 13N - 1323, Toronto, Ontario, M5G 2N2 Canada
| | - Rupert Kaul
- University Health Network, 585 University Ave., 13N - 1323, Toronto, Ontario, M5G 2N2 Canada
| | - Beatriz Grinsztejn
- Instituto de Pesquisa Clínica Evandro Chagas (IPEC), Fundação Oswaldo Cruz, Avenida Brasil, 4365 - Manguinhos, 21040-900, Rio de Janeiro - RJ - Brazil
| | - Pedro Cahn
- Fundación Huesped, Angel Peluffo 3932, Buenos Aires, Argentina, C1202ABB
| | - Sharon L Walmsley
- University Health Network, 585 University Ave., 13N - 1323, Toronto, Ontario, M5G 2N2 Canada
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Rodrigues J, Grinsztejn B, Bastos FI, Velasque L, Luz PM, de Souza CTV, Georg I, Pilotto JH, Veloso VG. Seroprevalence and factors associated with herpes simplex virus type 2 among HIV-negative high-risk men who have sex with men from Rio de Janeiro, Brazil: a cross-sectional study. BMC Infect Dis 2009; 9:39. [PMID: 19335922 PMCID: PMC2670309 DOI: 10.1186/1471-2334-9-39] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 04/01/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Herpes simplex virus type 2 (HSV-2) is the leading cause of genital ulcer disease in developing countries, including Brazil, and is especially prevalent among men who have sex with men (MSM). HSV-2 infection represents a risk factor for the acquisition and transmission of other sexually transmitted diseases. The goal of the present cross-sectional study was to estimate HSV-2 seroprevalence and to determine the factors associated with HSV-2 seropositivity in HIV-negative high-risk MSM from Rio de Janeiro, Brazil. METHODS Stored sera were tested to estimate HSV-2 seroprevalence, while socio-demographic and sexual behavior data were used to measure associations between risk factors and HSV-2 seropositivity. Using the Poisson regression model with robust variance, prevalence ratios (PR) were used to estimate de degree of association between risk factors and HSV-2 seropositivity in bivariate and multivariate analyses. RESULTS Seroprevalence of HSV-2 was of 45.7% (184 out of 403). Factors independently associated with HSV-2 seroprevalence in the multivariate model were: older age (>or= 26 years, PR: 1.41 95% Confidence Interval: 1.11-1.78), non-white race (PR: 1.32 95%CI: 1.06-1.64), positive serology for syphilis (PR: 1.65 95%CI: 1.33-2.05), positive serology for hepatitis B (PR: 1.25 95%CI: 0.99-1.57), stable male partner in the past 6 months (PR: 1.42 95%CI: 1.12-1.79), and unprotected anal sex with a stable female partner (PR: 1.46 95%CI: 1.05-2.04) in the 6 months preceding the cross-sectional assessment. CONCLUSION The present study made evident a high prevalence of HSV-2 infection in a sample of HIV-negative high-risk MSM from Rio de Janeiro. This finding indicates the need and urgency for implementing integrated programs for the prevention of HSV-2 and other sexually transmitted diseases, and, in particular, programs targeting high-risk MSM.
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Affiliation(s)
- Junia Rodrigues
- Instituto de Pesquisa Clínica Evandro Chagas (IPEC), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
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