Ignite Creation Date:
2024-05-05 @ 11:53 AM
Last Modification Date:
2024-10-26 @ 9:15 AM
Study NCT ID:
NCT00164424
Status:
COMPLETED
Last Update Posted:
2012-09-11
First Post:
2005-09-09
Brief Title:
Episodic Acyclovir Therapy for Genital Ulcers
Sponsor:
Centers for Disease Control and Prevention
Organization:
Centers for Disease Control and Prevention
Study Overview
Official Title:
Impact of Episodic Acyclovir Therapy on Ulcer Duration and HIV Shedding From Genital Ulcers Among Men in South Africa
Status:
COMPLETED
Status Verified Date:
2012-09
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
The purpose of this study is to determine if acyclovir episodic treatment has an effect in ulcer healing and if it should be added to the syndromic management of genital ulcer disease
Detailed Description:
Background and Objectives Herpes simplex virus type 2 HSV-2 is the primary cause of genital ulcer and one of the most prevalent sexually transmitted infections STI worldwide HSV-2 has been recognized as a risk factor for HIV in multiple studies A substantial shift in the aetiology of genital ulcer disease GUD towards genital herpes has been noted in many countries in Africa especially those with mature HIV epidemics Some countries guided by the predominance of HSV-2 as the aetiology of GUD in their country are changing syndromic guidelines to include acyclovir as part of the treatment for GUD Little data is available to support this decision in terms of its effect on clinical course and its cost-effectiveness Yet substantial investment would be needed in poor countries to add acyclovir to their essential drug list Studies to determine the appropriateness of episodic acyclovir therapy for HSV-2 in the developing world are needed
Episodic therapy with acyclovir both as a treatment modality and as an HIV-prevention strategy is appealing in terms of cost and sustainability However it is not clear which will be its impact under field conditions in which there would be delay in symptom recognition and treatment initiation and whether these conditions could be optimized through patient education We propose to conduct a randomized placebo-controlled trial of the effect of HSV-2 episodic therapy on symptomatic herpes and on HIV shedding from genital ulcers This study will help answer the question if acyclovir therapy for herpes should be added into the syndromic management of genital ulcer disease Acyclovir has an acceptable profile for widespread STI treatment and is now relatively inexpensive and well-tolerated Given that HSV-2 is the leading cause of GUD in the developing world this approach could have great public health importance by providing a safe acceptable and cost-effective method to treat genital ulcer disease and potentially reduce HIV transmission If acyclovir therapy reduces HIV shedding its incorporation into syndromic management would provide and effective way to scale it up as a public health intervention
Methods We plan an individually randomized double blind placebo-control trial of the WHO and US CDC recommended dose of 3-times daily acyclovir for a 5-day treatment course The trial will be conducted at two primary health care clinics in Johannesburg South Africa A total of 600 men presenting to the clinic with GUD will be enrolled in the study Consenting participants will be randomized to receive either acyclovir plus syndromic management or placebo plus syndromic management Syndromic management for genital ulcer disease will consist of one dose antibiotics to cover for syphilis and chancroid Participants will be followed for a month during follow-up visits duration of ulcers ulcer number and size will be evaluated and ulcer blood and semen samples collected to test for HIV RNA viral loads among HIV-positives and for HSV-2 shedding
Timeline Duration of the project is 2 years
Expected Outcomes The main outcome of the study will be the evaluation of the impact of acyclovir therapy on ulcer healing We will also measure the impact of acyclovir therapy on HIV and HSV-2 viral load from genital ulcers and HIV viral load in semen
Episodic therapy with acyclovir both as a treatment modality and as an HIV-prevention strategy is appealing in terms of cost and sustainability However it is not clear which will be its impact under field conditions in which there would be delay in symptom recognition and treatment initiation and whether these conditions could be optimized through patient education We propose to conduct a randomized placebo-controlled trial of the effect of HSV-2 episodic therapy on symptomatic herpes and on HIV shedding from genital ulcers This study will help answer the question if acyclovir therapy for herpes should be added into the syndromic management of genital ulcer disease Acyclovir has an acceptable profile for widespread STI treatment and is now relatively inexpensive and well-tolerated Given that HSV-2 is the leading cause of GUD in the developing world this approach could have great public health importance by providing a safe acceptable and cost-effective method to treat genital ulcer disease and potentially reduce HIV transmission If acyclovir therapy reduces HIV shedding its incorporation into syndromic management would provide and effective way to scale it up as a public health intervention
Methods We plan an individually randomized double blind placebo-control trial of the WHO and US CDC recommended dose of 3-times daily acyclovir for a 5-day treatment course The trial will be conducted at two primary health care clinics in Johannesburg South Africa A total of 600 men presenting to the clinic with GUD will be enrolled in the study Consenting participants will be randomized to receive either acyclovir plus syndromic management or placebo plus syndromic management Syndromic management for genital ulcer disease will consist of one dose antibiotics to cover for syphilis and chancroid Participants will be followed for a month during follow-up visits duration of ulcers ulcer number and size will be evaluated and ulcer blood and semen samples collected to test for HIV RNA viral loads among HIV-positives and for HSV-2 shedding
Timeline Duration of the project is 2 years
Expected Outcomes The main outcome of the study will be the evaluation of the impact of acyclovir therapy on ulcer healing We will also measure the impact of acyclovir therapy on HIV and HSV-2 viral load from genital ulcers and HIV viral load in semen
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None