Vitamin A Supplementation and Genital Shedding of Herpes Simplex Virus among HIV‐1–Infected Women: A Randomized Clinical Trial

Department of Laboratory Medicine, University of Washington Seattle, Seattle, Washington, United States
The Journal of Infectious Diseases (Impact Factor: 6). 05/2004; 189(8):1466-71. DOI: 10.1086/383049
Source: PubMed


Cross-sectional analyses have associated vitamin A deficiency with genital shedding of herpes simplex virus (HSV) among human immunodeficiency virus type 1 (HIV-1)-infected women. A randomized clinical trial of vitamin A supplementation given daily for 6 weeks was conducted among 376 women in Mombasa, Kenya, who were coinfected with HSV-2 and HIV-1. At follow-up, there was no significant difference in the detection of genital HSV DNA between women receiving vitamin A supplementation and women receiving placebo (40% vs. 44%, respectively; P = .5) Among women shedding HSV, there was no significant difference in the mean HSV DNA quantity between the group that received vitamin A supplementation and the group that received placebo (4.51 vs. 4.67 log10 copies/swab; P = .6). HSV shedding was associated with significantly higher vaginal and cervical HIV-1 shedding, even after controlling for the plasma HIV-1 load and the CD4 count. Vitamin A supplementation is unlikely to decrease HSV shedding and infectivity.

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    • "HSV2, in turn, has a strong impact on HIV transmission and acquisition, and may also affect the natural history of HIV infection [3,5–10]. A meta-analysis of longitudinal studies found HSV2 seropositivity to be associated with a risk ratio of HIV acquisition of 2.7 (95% confidence interval (CI) = 1.9– 3.9) in men and 3.1 (95% CI = 1.7–5.6) in women [11] and most cross-sectional studies have found a correlation between HSV2 and frequency and/or quantity of HIV mucosal shedding [12] [13] [14]. HSV2 prevalence and the estimated proportion of HIV infections attributable to HSV2 (population attributable fraction, PAF) are very high in sub-Saharan Africa (Africa) and therefore HSV2 control could have a substantial population-level impact on the HIV epidemic © 2009 Elsevier Ltd. ⁎Corresponding author. "
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    • "Sexual transmission of HIV-1 is suspected to be increased when HSV-2 is shed in the genital tract of dually HIV-1- and HSV-2-infected individuals [19,20]. HSV-2 may increase the infectiousness of HIV-infected subjects, by increasing genital HIV load during an HSV-2 genital recurrence [5-8] through the transactivation of HIV-1 LTR by interaction with HSV proteins (ICPO, ICP4) or the production of pro-inflammatory chemokines known to enhance HIV-1 replication [9,10]. The recruitment of activated CD4+ cells [12]that markedly upregulate HIV replication in HSV-infected lesions [13] may also account for the high titer of HIV in genital HSV lesions. "
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