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Avatar universal

Suppression Therapy Medication Effect on HSV testing

1.5 years ago, as part of a study looking for HIV-, HSV2+ gay men, I was diagnosed with HSV2.  They used the Focus EIA to determine my status. With this study you are placed on either acyclovir or placebo, unknown to the participant. The study continues until next month.

I have never experienced any noticeable outbreaks (before or after this test), either oral or genital.  I want to determine my HSV1 status.  I went to my PCP and got tested, with what I thought was a western blot (I saw it on the lab intake form).  They called and told me the results for both HSV1 and HSV2 were indeterminate.  

Since this, I have read that being on suppression therapy can give a false-negative result for HSV testing.  Perhaps this is due to the fact there is no viral reactivation and antibody levels decease to undetectable levels.

I want to be tested for a third time to clear this up and get my HSV1 status, but I also want a true result.

How long should one be off suppression medication to get a reliable HSV test result?

6 Responses
239123 tn?1267651214
MEDICAL PROFESSIONAL
It sounds like you are a subject of HPTN (HIV Prevention Trials Network) protocol no. 039; or if not that study, a related one.  These are international research trials designed to determine whether treating HSV-2 infected people with acyclovir will reduce their risk of acquiring HIV.  The international principal investigator is a friend and colleague of mine.  Trust me on this:  the researchers are going to make absolutely certain that their study subjects are accurately classified as to whether or not they have HSV-2.  It's a good bet they didn't stop with Focus, but might already have done a Western blot. If not, they will be interested to know of your subsequent test results in a different lab, and will do whatever is necessary to sort it out, at no cost to you.  Give them a call.  (Take this message to them, and give them my regards.)

Being on suppressive therapy has no effect on HSV blood test results.

You are involved in one of the most important HIV prevention trials ever designed, and if acyclovir turns out to prevent HIV in such people, it might one day be viewed as one of the most important public health prevention trials of all time.  On behalf of medical science, and especially on behalf of all people at risk for herpes and HIV infection, thank you for your service as a research subject.

Good luck--  HHH, MD
Avatar universal
If in fact they determined that acyclovir decreased the risk of contracting HIV in gay men with HSV, what would be the clinical recommendations to come out of a study like this?

More generally, are studies like this always population-specific? (e.g., I believe I read that the Valtrex study doesn't have indications for gay couples)
Avatar universal
Dr. Handsfield,

Yes I am involved with the study through the UW.  My PHP is also suppose to send me a copy of the second test results. I will call the study group to ask them to help clear this all up - thanks for the info.

In case you are curious, on yoshi2me was where I was hearing of another case of false-negative HSV test results (and linked where Herpeselect refers on their website that antivirals can affect their test results).

http://www.yoshi2me.com/phpbb/viewtopic.php?t=5065
Avatar universal
I can only speak as a participant in this study (and my observations):
I think the hypothesis is that people with HSV2 may have "micro-lesions" on the skin due to HSV2 outbreaks that cannot be seen.  The lesion would allow greater access and increased transmission of HIV.  By taking acyclovir it would reduce having the herpes micro-lesions and thus HIV transmission.  Perhaps their recommendation would be for HSV2+ individuals at higher risk for contracting HIV to take acyclovir (or other suppression medication).
239123 tn?1267651214
MEDICAL PROFESSIONAL
I am unfamiliar with yoshi2me.com, but the home page provides no info about who runs the website, which suggests it is not a professional expert in herpes (otherwise s/he would make it obvious). On quick glance, some information appears well written and accurate, but the person who responded to your question does not know what s/he is talking about. The fact that treatment does not affect test results is not a matter of debate or uncertainty.

But why are you seeking advice from anyone other than the investigators of your research study? They, and especially those in Seattle, are at the world's pinnacle of herpes expertise; most of what we know about HSV epidemiology, transmission, prevention and diagnosis came from that research group. Asking your own health care provider, another website, or anyone else--including me--in preference to them is really a waste of your time and energy.

The 039 protocol emphasizes gay men in some settings (e.g., Seattle, NYC, and Lima, Peru) and heterosexual men and women in places where heterosexual HIV transmission is common, like sub-Saharan Africa. Your personal theory of why this might work is exactly right, the very basis of the 039 study, and the potential outcome you describe is exactly what is hoped. In southern Africa alone, in theory treating HSV-2 infected persons might prevent millions of HIV infections over a few years.
101028 tn?1419606604
yoshi2me is a HELP group coordinator. Most of the other people who post on her site aren't and are simply others living with herpes trying to help others.  They are all quite helpful but their advice should never replace that of a medical professional.

grace
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