Acyclovir and Herpes Type-1

[Boze]

Hello,

Does anybody know if Acyclovir can help someone who has Herpes Type-1 (oral)? I seem to read conflicting evidence in literature.

Thank you very much

[scotti2427]

Hi borzel,

I can confirm that Aciclovir and Valaciclovir both help with Herpes simplex.  I've been on Aciclovir on and off for about 5 years and just recently switched to Valaciclovir for the convenience.

If I take a break from taking the drug, I get cold sores all round my mouth and they keep coming back.  When taking the drug, I don't have any at all.

If your having an outbreak then your Doctor will give you a stronger dose usually for 3 days before coming down to the maintenance dose.

Scott

[Boze]

Thanks, Scotti.

I guess I should explain myself better. I don't actually have any issues with Herpes - maybe get a mouth ulcer once every few years. But I read that taking acyclovir helps suppress HIV virus IF you have herpes. So I am considering taking it (before I start ARV) to deal with HIV. I am not sure, though, if having Herpes-1 qualifies me - ie if Acyclovir will help with HIV suppression.

[Inchlingblue]

Acyclovir (and Valacyclovir) has been shown to have anti-HIV properties only if the person is co-infected with HSV (1 or 2); IOW, if a person has HIV but not HSV it would not have an effect on HIV.

Here's some more info:

http://forums.poz.com/index.php?topic=31431.msg384457#msg384457

[Boze]

Got it - so you think it would help with HSV-1? I think I have that (ie not HSV-2)

[Inchlingblue]

Got it - so you think it would help with HSV-1? I think I have that (ie not HSV-2)

If you have either one it could help with the HIV. That's what some studies show. It has to be taken every day, just like the HIV meds.

I went on Valtrex before I started HIV meds and my HIV viral load did go down from about 24K to about 9K. There's no way to absolutely prove it was due to the Valtrex but, considering studies have shown that it can lower HIV viral load, it would not be unreasonable to assume it was.

I stopped the daily Valtrex when I went on HIV meds, I want to take as few drugs as possible and I have not had a herpes outbreak in many years. I've only had 2-3 outbreaks in my life (on the lips) and they were mild ones.

I guess you should make sure you have HSV (either 1 or 2) because if you don't then there's no point in taking it. A blood test can check for antibodies.

[Matty the Damned]

Valacyclovir is probably more convenient to take than acyclovir. Either drug is active against both HSV1 and HSV2. I'm not entirely sure that the 1/2 distinction is necessary, but that's a different matter.

MtD

[Boze]

Inchlingblue, Thank you for clarification. We seem to be following the same train of thought but with a time-lag. I am just thinking of taking this before I go on ARV.

Matty, thanks. Why is one easier than the other?

[Boze]

By the way - this is where I got the idea that there is a difference between HSV1 and HSV2 with respect to HIV: http://content.nejm.org/cgi/content/short/NEJMoa0904849v1?rss=1&query=current

ABSTRACT

Background Most persons who are infected with human immunodeficiency virus type 1 (HIV-1) are also infected with herpes simplex virus type 2 (HSV-2), which is frequently reactivated and is associated with increased plasma and genital levels of HIV-1. Therapy to suppress HSV-2 reduces the frequency of reactivation of HSV-2 as well as HIV-1 levels, suggesting that suppression of HSV-2 may reduce the risk of transmission of HIV-1.

Methods We conducted a randomized, placebo-controlled trial of suppressive therapy for HSV-2 (acyclovir at a dose of 400 mg orally twice daily) in couples in which only one of the partners was seropositive for HIV-1 (CD4 count, 250 cells per cubic millimeter) and that partner was also infected with HSV-2 and was not taking antiretroviral therapy at the time of enrollment. The primary end point was transmission of HIV-1 to the partner who was not initially infected with HIV-1; linkage of transmissions was assessed by means of genetic sequencing of viruses.

Results A total of 3408 couples were enrolled at 14 sites in Africa. Of the partners who were infected with HIV-1, 68% were women, and the baseline median CD4 count was 462 cells per cubic millimeter. Of 132 HIV-1 seroconversions that occurred after randomization (an incidence of 2.7 per 100 person-years), 84 were linked within couples by viral sequencing: 41 in the acyclovir group and 43 in the placebo group (hazard ratio with acyclovir, 0.92, 95% confidence interval [CI], 0.60 to 1.41; P=0.69). Suppression with acyclovir reduced the mean plasma concentration of HIV-1 by 0.25 log10 copies per milliliter (95% CI, 0.22 to 0.29; P<0.001) and the occurrence of HSV-2–positive genital ulcers by 73% (risk ratio, 0.27; 95% CI, 0.20 to 0.36; P<0.001). A total of 92% of the partners infected with HIV-1 and 84% of the partners not infected with HIV-1 remained in the study for 24 months. The level of adherence to the dispensed study drug was 96%. No serious adverse events related to acyclovir were observed.

Conclusions Daily acyclovir therapy did not reduce the risk of transmission of HIV-1, despite a reduction in plasma HIV-1 RNA of 0.25 log10 copies per milliliter and a 73% reduction in the occurrence of genital ulcers due to HSV-2. (ClinicalTrials.gov number, NCT00194519 [ClinicalTrials.gov] .)

[Matty the Damned]

Inchlingblue, Thank you for clarification. We seem to be following the same train of thought but with a time-lag. I am just thinking of taking this before I go on ARV.

Matty, thanks. Why is one easier than the other?

It's about dosing. Valtrex (valacyclovir) can be taken as 1 tablet a day. Ultimately both drugs do the same thing but if memory serves with acyclovir you take more tablets more than once a day.

In any event Valtrex is often the preferred treatment these days.

As for the difference between HSV1 and HSV2 - that's an opinion of mine and not a particularly well thought out one.

MtD

[Inchlingblue]

The studies have found that the phosphorylated form of acyclovir has a direct effect on HIV. Acyclovir becomes phosphorylated when it has come into contact with various types of HSV (1 and 2 and other types of HSV as well). According to the NIH article, link below, "it’s reasonable to assume that most of these viruses have the ability to alter acyclovir so that it hinders HIV,"

Acyclovir in its phosphorylated form seems to have a direct effect on HIV reverse transcriptase (there's actually an HIV mutation associated with acyclovir use, but it's not an important one and doesn't limit the use of most HIV ARVs).

Another reason why acyclovir seems to lower HIV levels is more indirect and likely due to the fact that HIV and HSV "spur each other on," to describe it in layman's terms. When both viruses are present, in the absence of meds, they help each other thrive and replicate (think Matty and Miss P going at it). So in controlling HSV, HIV is also indirectly controlled.
 
As Matty states valacyclovir is dosed once a day so it's more convenient. Known as Valtrex in the US, it's not available in generic form so it's more expensive. It's essentially the prodrug version of acyclovir, so it allows for better absorption, hence, it can be taken once daily. Acyclovir is available in generic so it's cheaper.

LINK:

http://www.nih.gov/news/health/sep2008/nichd-10.htm

[Boze]

Matty, Inchling thank you very much for your explanations, much appreciated.

Slightly off-topic - Inchling - do you have any discomfort/regret from starting meds (in a sense that you would prolong being off them if you could)?

[Inchlingblue]

Slightly off-topic - Inchling - do you have any discomfort/regret from starting meds (in a sense that you would prolong being off them if you could)?

When I first tested I had a fairly low VL, 24K and my CD4s were around 620 or so. The thing is I became extremely anxious and stressed which cause my CD4s to drop to about 320 in only 3 weeks, which is a pretty major drop. After that they recovered somewhat, to about 450. I went on Valtrex and was taking other supplements such as NAC and astragalus and selenium. My viral load dropped to about 9K but my CD4s basically fluctuated between 320-430 for about a year and that's when I decided to start.

I realized that my CD4s were not going to go above 500 on their own, after that huge drop I had and I was not happy with CD4s below 500 (even though they were above 325).

Given all the pros and cons, here's how I basically feel about it at this point in time (based on existing meds): If the viral load is below 50K and the CD4s are above 500, I would wait. If the CD4s dip below 500 I'd start and if the VL went over 50K I'd start (not if both those things happen, but if either one happened).

I don't regret starting, because my CD4s were consistently below 500 for almost a year. My biggest fear with HIV is not having access to health care and to the meds. I feel great physically and if it were not for the reminder of taking the meds every day, I would not feel like anything was wrong.

If I had found out as early as you have (you said that you got HIV very recently, right?), I might have started meds. There's something to be said about starting meds very soon after seroconversion since it's been shown that reservoirs are smaller and made up of fewer type of memory T Cells within the first year of infection. This could possibly have an impact with future therapies looking at eradicating HIV from reservoirs.

[Boze]

Thank you very much, Inch.

Unfortunately I've been infected almost 2 years ago (Aug-08) so I'm not really at that stage. However, your experience on ARV sounds very encouraging. Right now I've put myself on a pretty hearty supplement regimen (oodles of pills a day), so moving to only 3 a day may be actually less hassle

[Inchlingblue]

I've been reading that there's a shortage of acyclovir lately.

LINK:

http://www.hopkins-aids.edu//q_a/patient/recent_questions/herpes_meds_in_short_supply.html?contentInstanceId=525162&siteId=7151

[leatherman]

I've been reading that there's a shortage of acyclovir lately.

an interesting Q&A over in this thread
http://www.medhelp.org/posts/Herpes/Acyclovir-Shortage-in-the-US/show/1165349

Teva has a shortage of acyclovir and Valtrex just went generic in Dec (and is still more expensive than acyclovir). Reading thru that thread, I noticed that over the last 5 months my pharmacy too has changed manufacturers of my acyclovir 3 times and the latest refill was of valtrex. It's either a shortage or a conspiracy.... or both