Episodic therapy for genital herpes in sub-Saharan Africa: a pooled analysis from three randomised controlled trials

Abstract

This study aimed to describe the clinical characteristics of 1478 genital ulcer disease cases in 4 African countries (Ghana, the Central African Republic, Malawi and South Africa), to estimate the impact of acyclovir on ulcer healing (among all patients, and among subgroups by HIV serostatus, type of ulcer, time to presentation, and size of ulcer), and to estimate the impact of acyclovir on lesional and genital HIV-1 shedding. Overall, patients on acyclovir were more likely to have a healed ulcer on Day 7 (63% vs 57%, RR=1.10, 95%CI 1.00-1.21) and a shorter time to ulcer healing (p=0.04), but this effect was only seen in South Africa. The benefit of acyclovir was largely confined to patients with HSV-2 ulcers (RR=1.22, 95%CI 1.0-1.4), with little effect among those without ulcers of other or unknown cause (RR=1.05, 95%CI 0.8-1.3). There was some evidence of a stronger impact among HIV-1 positive than negative patients (RR=1.17, RR=1.02, respectively). Small ulcers (2) responded better to treatment, but there was no difference by time before presentation. There was some effect on genital and lesional HIV at Day 7 among men, but not among women