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@article{Baggaley:2009:10.1097/QAD.0b013e32832aadf2,
author = {Baggaley, RF and Griffin, JT and Chapman, R and Hollingsworth, TD and Nagot, N and Delany, S and Mayaud, P and de, WF and Fraser, C and Ghani, AC and Weiss, HA},
doi = {10.1097/QAD.0b013e32832aadf2},
journal = {AIDS},
pages = {1005--1013},
title = {Estimating the public health impact of the effect of herpes simplex virus suppressive therapy on plasma HIV-1 viral load},
url = {http://dx.doi.org/10.1097/QAD.0b013e32832aadf2},
volume = {23},
year = {2009}
}

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TY  - JOUR
AB  - Objective: Trials of herpes simplex virus (HSV) suppressive therapy among HSV-2/HIV-1-infected individuals have reported an impacton plasma HIV-1 viral loads(PVLs). Our aim was to estimate the population-level impact of suppressive therapy on female-to-male HIV-1 sexual transmission.Design and methods: By comparing prerandomization and postrandomization individual-level PVL data from the first two HSV suppressive therapy randomized controlled trials in sub-Saharan Africa, we estimated the effect of treatment on duration of asymptomatic infection and number of HIV-1 transmission events for each trial.Results: Assuming that a reduction in PVL is accompanied by an increased duration of HIV-1 asymptomatic infection, 4-6 years of HSV suppressive therapy produce a 1-year increase in the duration of this stage. To avert one HIV-1 transmission requires 8.8 [95% confidence interval (CI), 5.9-14.9] and 11.4 (95% Cl, 7.8-27.5) women to be treated from halfway through their HIV-1 asymptomatic period, using results from Burkina Faso and South African trials, respectively. Regardless of the timing of treatment initiation, 51.6 (95% Cl, 30.4-137.0) and 66.5 (95% Cl, 36.7-222.6) treatment-years are required to avert one HIV-1 infection. Distributions of set-point PVL values from sub-Saharan African populations suggest that unintended adverse consequences of therapy at the population level (i.e. increased HIV-1 transmission due to increased duration of infection) are unlikely to occur in these settings.Conclusion: HSV suppressive therapy may avert relatively few HIV-1 transmission events per person-year of treatment. Its use as a prevention intervention may be limited; however, further research into its effect on rate of CD4 cell count decline and the impact of higher dosing schedules is warranted. (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins
AU  - Baggaley,RF
AU  - Griffin,JT
AU  - Chapman,R
AU  - Hollingsworth,TD
AU  - Nagot,N
AU  - Delany,S
AU  - Mayaud,P
AU  - de,WF
AU  - Fraser,C
AU  - Ghani,AC
AU  - Weiss,HA
DO  - 10.1097/QAD.0b013e32832aadf2
EP  - 1013
PY  - 2009///
SN  - 0269-9370
SP  - 1005
TI  - Estimating the public health impact of the effect of herpes simplex virus suppressive therapy on plasma HIV-1 viral load
T2  - AIDS
UR  - http://dx.doi.org/10.1097/QAD.0b013e32832aadf2
UR  - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763398
VL  - 23
ER  -

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