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Suppressive Valacyclovir Therapy: Impact on the Population Spread of HSV-2 Infection

Williams, John R. DPhil*; Jordan, Jamie C. PharmD; Davis, E Anne PharmD; Garnett, Geoffrey P. PhD*

Sexually Transmitted Diseases: March 2007 - Volume 34 - Issue 3 - p 123-131
doi: 10.1097/01.olq.0000258486.81492.a2
Article

Objectives: Recent trial results demonstrate that the transmission probability of HSV-2 in monogamous couples is nearly halved by the use of valacyclovir as suppressive therapy.

Goal: The goal of this study is to understand the potential impact of suppressive valacyclovir therapy on the transmission of HSV-2 within a population.

Study Design: A mathematical model of HSV-2 epidemiology was developed which included suppressive therapy with the efficacy observed in the clinical trial. The model represented HSV-2 spread in an age and sexual activity stratified population where rates of viral shedding declined based on time since infection. The model tested the impact of a range of suppression coverage levels.

Results: Suppressive therapy reduces the population incidence of HSV-2. With coverage rates of 3.2%, the incidence of HSV-2 would be reduced by between 1.8% and 2.8%. Higher coverage rates were estimated to reduce the incidence of new cases up to 13%. Starting suppression closer to the time of infection also reduces the incidence of new cases.

Conclusion: The impact of suppressive therapy on the HSV-2 epidemic is modest at current coverage levels but could be substantially increased with higher rates of diagnosis and a focus on coverage soon after infection.

An epidemiologic model of HSV-2 transmission showed that the impact of suppressive therapy on the HSV-2 epidemic could be substantially increased with higher rates of diagnosis and a focus on coverage soon after infection.

From the *Division of Epidemiology, Public Health and Primary Care, Imperial College London, United Kingdom; and †GlaxoSmithKline, Research Triangle Park, North Carolina

The authors thank Josephine Mauskopf for her assistance in preparing the manuscript.

This study was supported by a grant from GlaxoSmithKline.

Correspondence: John R. Williams, DPhil, Division of Epidemiology, Public Health and Primary Care, Imperial College London, St. Mary’s Campus, Norfolk Place, W2 1PG, London, United Kingdom. E-mail: jr.williams@imperial.ac.uk.

Received for publication December 6, 2005, and accepted November 28, 2006.

© Copyright 2007 American Sexually Transmitted Diseases Association