KHOPOTSO: Some research data, including one conducted in South Africa in 2001, indicate that when a person is HIV-positive and is infected with Herpes Simplex Virus-2, the latter infection immensely increases the concentration levels of the HI-virus in a person’s genital secretions. But when Acyclovir is administered the viral load decreases. Researchers hope that this decrease in the amount of HIV during treatment of herpes will result in reduced levels of HIV transmission. Ghanaian-born Dr Yaw Adu-Sarkodie, Dr Sarks to colleagues and patients, is the Senior Researcher in the study conducted by Wits University’s Reproductive Health & HIV Research Unit.
Dr YAW ADU-SARKODIE: If you have HIV and you have herpes as well and you are given a drug called Acyclovir the amount of HIV in your body also drops. Now, what researchers do not know is: If the amount of HIV in you drops, what does it mean in terms of transmission? Will it help to prevent transmitting HIV to your partner or will it reduce the chances of transmission?
KHOPOTSO: Dr Sarks says the research is based on a similar view, though not sufficiently proven, held by the medical profession on the influence of antiretrovirals on the transmission levels of HIV.
Dr YAW ADU- SARKODIE: For instance, it is hoped that people who are on ARVs, when the amount of HIV in them drops it is hoped that this will sort of prevent them or reduce their transmission. It is much the same phenomenon we are looking at, that in somebody who has HIV, who also has herpes genitalis, who is not on ARVs, if we give that person a drug called Acyclovir and the viral load of HIV in them comes down, will it prevent their transmitting HIV to their partner who is not infected?
KHOPOTSO: Genital ulcers due to Herpes Simplex Virus-2 are the most common of all sexually transmitted infections found in southern Africa. Genital ulcers make it easier for HIV to enter a person’s body and some researchers that widespread herpes infections may be driving the HIV epidemic in the sub-region. However, not all people who have herpes will display symptoms, which first start as an itchy and painful rash and later small blisters develop and then break, leaving painful sores. That means that a greater majority, about 60 ‘ 80%, of people who have herpes don’t know they have it. Only a blood test can show that a person is infected. Thirty-five year-old Thabang, of Zone 14 in Orange Farm, is one of such asymptomatic people.
He points at a picture in a booklet showing quite graphically how damaged sex organs can look when a person has symptoms.
THABANG: No, I don’t have any of this. I don’t have nothing like this. Even now I feel tough. I don’t feel sick. I know I have something like this. That is why I want to treat it so it doesn’t become like this one.
KHOPOTSO: Thabang was diagnosed with herpes two months ago. At that time he was also found to have HIV. Fortunately for him, he is still well. His CD 4 count indicates that he is still far from having to take antiretrovirals. For purposes of the study a high CD 4 count where a person is not taking anti-AIDS medicine is one of the criteria for eligibility to participate.
Dr YAW ADU-SARKODIE: His CD 4 count was 700. He has a very high CD 4 count. He’s a well HIV-positive person.
KHOPOTSO: The study promotes couples’ HIV testing and counselling where both partners in a relationship are tested together simultaneously and their HIV status is revealed to them both in the same manner as the test was conducted.
The emphasis is on couples’ HIV testing and counselling because it is believed that most HIV infections ‘ 2 in 3 ‘ occur in stable relationships. In addition to the HIV test, the couples undergo screening for Herpes Simplex Virus-2. Study participants are recruited from a pool of couples whose test results are discordant, that is, where one partner is HIV as well as herpes-positive and the other negative.
It is important that participants understand that Acyclovir, the medication for herpes, will not protect the uninfected partner from contracting HIV from the infected one. As a result, the couples are provided with free condoms to practice safe sex for the duration of the 12-month study. Thabang’s partner, Mmapaseka – who is HIV negative – reckons that as a couple, they have learnt a lot from the couples’ HIV testing and counselling offered under the auspices of the study.
MMAPASEKA: I didn’t use a condom. But now I don’t have a problem. I enjoy a condom because our status is our life, you see. I must try to use a condom, yes.
KHOPOTSO: Acyclovir has been used for over 20 years in the treatment of infections caused by the herpes virus. If this research proves successful it would bring on to the market a new weapon in the fight against HIV.
E-mail Khopotso Bodibe