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Presented by : Shinta Tantri Amanda, S.Ked 2008730036 PEMBIMBING : Dr. Rizqa Haerani, Sp.KK
Background
Methods
Results
Discussion
Herpes simplex virus (HSV) type 2 (HSV-2), the most common cause of genital ulcer disease
Background
Methods
Results
Discussion
Several
studies
have
demonstrated
increased
genital shedding of HIV-1 during symptomatic and asymptomatic recurrences of herpetic episodes, suggesting that HSV-2 may increase replication of HIV type 1 (HIV-1), as has been supported by
biological evidence
WHO recommend antiherpetic therapy for patients with genital ulcer disease However, herpes therapy is seldom used in resource-poor settings, and not
Background
Methods
Results
Discussion
Background
Methods
Results
Discussion
The Agence Nationale de Recherches sur le SIDA et les He-patites (ANRS) 1212 trial was an individually randomized placebo-controlled trial of
Background
Methods
Results
Discussion
Women with clinically conrmed ulcers or blisters in African were eligible for recruitment into the study if they were 18 years of age and resided and planned to stay for 1 month. Exclusion criteria :
Menstruation; pregnancy (as determined by urine testing; contraindications to acyclovir (e.g., suspected renal impairment or allergy to acyclovir); and the presence of large ulcers (surface area, 500 mm2), chronic ulcers(duration,11 month), or perianal ulcers only, which prompted provision of open-label acyclovir.
Background
Methods
Results
Discussion
Women who provided consent were interviewed, examined and had genital and blood samples collected Study participants received directly observed single-dose syndromic treatment for chancroid (500mg ciprofloxacin oral) and syphilis (2,4 jt U penicilin IM), counseling about STD and HIV, partner notification slips and condom. Participants were asked to return to the clinic on day 2 and/or day 4 and on days 7,14, and 28 At each clinic visit, a pelvic examination and genital samples collected
Background
Methods
Results
Discussion
Specimen collection and laboratory procedures. Study denitions. HIV-1 infection as detec-tion of HIV-1 either in a cervicovaginal lavage specimen or serologically. A nonprimary rst episode of genital HSV-2 infection was dened as detection of HSV-2 DNA in the lesion of or cervicovaginal lavage specimen obtained from women who were HSV-1 seropositive and HSV-2 seronegative. We used 2 denitions of ulcer healing at each clinic visit: (1) a 90% reduction in the surface area of the largest ulcer, compared with its size at D0, and (2) the proportion of patients whose largest ulcer was 10 mm2 .
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Background
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Background
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Background
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Background
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determined
analysis)
by
among
Kaplan-Meier
118 virus human type 1
immunodeciency
infected women with herpes simplex virus type 2 ulcers in Ghana and the Central African Republic. * P=.21 was estimated from Cox regression,
Background
Methods
Results
Discussion
Background
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Discussion
The rationale for this study was multifold First, epidemiologic and biological evidence has suggested an important role of HSV in enhancing HIV
Background
Methods
Results
Discussion
Second, the strong association of HIV transmission with genital ulcer disease
suggests that a substantial proportion of HIV transmissions may take place during clinical ulcer episodes, including in settings where the majority of ulcers are caused by HSV-2
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Results
Discussion
Because the majority of ulcers in developing countries are caused by HSV-2, particularly among HIV-positive patients, the World Health Organization recommends adding acyclovir
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HIV-1infected individuals.
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power calculations
Exclusion (for ethical reasons) of patients with more-severe herpetic ulcers may limit the
conclusion
In conclusion, our results indicate that, among HIV-infected women, the use of acyclovir in accordance with current recommendations for the management of genital ulcer