long term expectations and antiviral medications

[gogoboy]

i'm curious that while i read that anitviral suppresive therapy is effective for the treatment of genital herpes, i wonder if there is any indication that it hampers the bodies natural tendency to become more immune to the virus. i've read that given time, the body will naturally suppress the virus to a certain extent (although it may take years) but would antivirals simply be preventing the body from doing so?

any information much appreciated.

[gracefromHHP]

In medicine nothing is absolute.  On the boards we tend to talk in general - for what applies to the vast majority of folks infected with herpes.  There will always be exceptions - no matter what condition we are talking about be it herpes, hpv, common cold, gastric reflux etc.  It's impossible for us to cover it all - especially the exceptions to the rules. The purpose of an online ( and free ) message board is to help guide you in the right direction more than anything.  Even paying your $15 here for the std experts isn't the same level of care you'd get if you paid the $125 to sit in their office with them.  

I would think that if the virus just runs out of genetic material in time, I should soon be ob free....lol.  Most of the newest research is showing that the number of actual ob's has more to do with genetic issues as well as chronic inflammatory issues ( also a risk for heart disease and stroke too ).   Also the skin's own immune response seems to have a lot to do with whether you'll get an obvious ob or not when the virus is actively shedding.  Lots and lots of little pieces of the puzzle out there but so far still missing the major pieces to put it all together completely.  We are all unique individuals and different in little ways from each other.  

As I said - it's up to you what you want to do.  You are gathering the info you need to make an informed decision.  Also how your partner feels is important too. Sometimes in a long term relationship, the uninfected partner even just gets a screw it just get it over with and give it to me so I can stop wondering if it will happen or not - believe it or not.  Of course usually when you are trying to get infected, you can't...lol.  Kinda like before the chicken pox vaccine when there'd be pox parties to try to get all the kids infected with chicken pox before they entered school to just get it over with.  

Hang in there and keep asking questions :)  Most of this thread has been pretty enjoyable to be honest!  

grace

[gogoboy]

thanks for the articles grace... this does seem to be somewhat under evaluated at the moment. as described in your last reference, there are a lot of variables to keep in mind.

its funny that if one just researches web sites with general information then they all indicate that ob's reduce over time and that a lot of this depends on how severe first out breaks and first year of infection are. there is a book on google books that even hypothesizes that the virus just runs out of genetic material after a while. that might make sense considering that if one has had a very bad primary infection then they simply have way more genetic material in their bodies.

of course, all of this is hypothetical if we are unable to discover any studies that support it!

[gracefromHHP]

http://www.annals.org/cgi/reprint/131/1/14.pdf    pretty sure that's the article I was thinking of.  running out of time today to read thru it completely to be sure but I know it's still an interesting article none the less.

grace

[gracefromHHP]

As for the medications being safe for long periods - we have 25+ years of info on acyclovir being taken suppressively. excellent article by dr tyring on valtrex, 20 years of acyclovir safety. We don't have as much info on famvir since penciclovir wasn't being as widely used as long as acyclovir has been.  

Also we have info on acyclovir and penciclovir resistance for 25+ years now too and the rates haven't increased at all if that was a concern.

Just keep asking questions :)

grace

[gracefromHHP]

The virus is most active during the first year - in fact one study showed that in newly infected people, on average hsv2 is active 40% of days via pcr.  Ob's ( and shedding ) are more frequent during the first year on most folks and then settles down after that for the most part.

  I believe this study you asked about looked at the 1st two years of being infected on average on women who were hsv1 negative prior to having their primary hsv2 infection and on average but it only looked at 10 weeks at a time in this small cohort of women ( as well as it seems they kept diary's for 2 years - not real sure from the study if it was 2 years or just diaries during those 10 week periods ).  It also showed that even though the number of obvious lesions decreased in some women, the rate of shedding didn't and in some of the women was still quite high 4-5 years after being infected ( if the study is pretty much greek to you - just go to the discussion section at the end and read that part - my eyes glazed over at the graphs/tables section myself even  ).  I wish it had more detail - will have to look around and see if I can find the original study that it used to get the info from to do the  modeling on - might have more of the info we are interested in.  

I can't recall which study it's from but one study showed that after 5 years of being infected, 25% of folks had less ob's, 25% had more and the rest all had about the same number of ob's. I don't think that study looked at viral shedding though. It was an older study.    Some of the additional studies from the valtrex and reduction in transmission study did have info on folks and their shedding patterns from 1-10 years of being infected and the study that is referenced in the webmd article I posted looked at >10 years of being infected in 100 participants if you are interested in more reading on all of this.  The majority of folks I know who have had hsv2 long term, have less ob's in general though they all seem to go thru periods where the pattern is increased for a short time ( like they won't get an ob for a year or two and then have 3 in a row in a few months or something similar ). Even my ob's have decreased in 22 years - I used to have 20 a year and the last time I was off suppressive therapy I had 14. It's an improvement!  When a friend of mine and I participated in the shedding study for folks infected >10 years, he rarely has ob's, I get them all the time - ironically he was shedding the virus more often than I was which surprised us quite a bit.  So you just never know is what I"m trying to say I guess.  ( http://racoon.com/dcforum/DCForumID22/2.html  is a link to a very unscientific ongoing poll we have on the herpes homepage if you want to read what real people with herpes have as far as ob's ).  

So do you ever have to treat your herpes? absolutely not! It's totally your choice.  My personal recommendations are, during the first year of being infected with hsv2, suppressive therapy is probably the best choice if you are interested - especially if you start a new relationship with a hsv2 - partner during that time.  I also recommend it during the first year or two of a new relationship with someone if it's a discordant relationship.  after that play it by ear. I know folks who have never, ever treated their herpes.  I know folks who have been on suppressive therapy from the gitgo and never plan to go off it.  Most folks I know change up and down depending on what's going on in their life and their health.   You need to look at it from your own situation and what you are comfortable with.  make sense?  What's right for one person, might not be the right choice for another on multiple levels.  I understand you are trying to make an informed choice about it though :)  

grace

[gogoboy]

i think everyone may know what i'm worried about here... most of the studies that i can find are associated with the proof that antiviral medications reduce ob's and shedding. i don't beleive there is any reason the refute these findings.

what i worry about is that before i allow myself to be convinced by drug companies that i need to be on antivirals for the rest of my life then i'd like a little more proof. this is more and more becoming the accepted knowledge about the condition without drug makers stepping up to the plate to provide studies prooving that the medication is safe for long periods.

i would appreciate anyone with more insight to review the following recent study whose conclusion is "Rates of HSV-2 reactivation, shedding and recurrence generally decline over time":
http://repositories.cdlib.org/postprints/2694/

the article is downloadable... this is the only article i can find at the moment that models hsv2 ob's and shedding without interference from anitvirals. i think we need more of this kind of information!

thanks again for participating!

[gracefromHHP]

http://content.nejm.org/cgi/content/full/342/12/844   - # of ob's doesn't mean less shedding

http://www.webmd.com/genital-herpes/news/20081030/herpes-often-unknowingly-spread?src=RSS_PUBLIC   scroll down to the shedding continues for more than a decade part - unfortunately they haven't officially published the study yet to link to that but it'll be out soon

those are 2 I found real quickly.

thanks for the article you mentioned too - interesting but 10% isn't a huge thing as far as it affecting the way the body helps with herpes and it also  shows that as soon as you stop suppressive therapy, igg goes right back up anyways.

grace

[gogoboy]

thanks for the pubmed.gov link... its very useful.

actually, getting back to my first question.. here is a link to a study that did find that viral suppression did decrease the bodies antibody levels by 10% in the first year.

http://www.ncbi.nlm.nih.gov/pubmed/3183633

[gracefromHHP]

I'm not at home so I don't have references handy but I'll try to remember to provide them for you tomorrow when I am at home.  You also can search yourself on pubmed.gov for them.  they should be easy to find.  I'm not sure what reading you've been doing but the rate of shedding has little to do with the number of obvious ob's and it doesn't decrease over time very much.

grace

[gogoboy]

um... do you have some references to these studies you supplied?

from my investigations it would appear confirmed that rates of shedding are highly associated in symptomatic individuals with the number occurences per year and over time the number of occurences generally reduces and along with it the number of viral shedding days.

of course, there will be individuals who do not display this general course but what i've described will be the majority of cases instead of the minority.

[gracefromHHP]

Studies have shown that you are shedding the virus about the same amount whether you are infected 2 years, 10 years or 20 years with hsv2.  A decrease in obvious genital symptoms doesn't correlate with a decrease in viral shedding.

Antivirals for herpes do not interfere with the way your body builds an immune response to herpes. It interferes with the viral replication process. No virus replicating, you just pee out the antivirals and they haven't done anything. If the virus is replicating, your body's innate immune response starts as well as the antivirals are able to disrupt the viral replication process so that it's less likely to cause shedding on the skin's surface as well as obvious genital lesions.

grace

[gogoboy]

well, that is interfering with the bodies exposure to it... no?

[auntiejessi]

Nope, the antivirals just stop the virus from replicating.  It doesn't do anything else, so it doesn't hamper the body from doing anything.   It works with your body, not for your body.

Aj