An Open-label Trial of the Effect of Valacyclovir on Plasma HIV-1 Levels Among HIV-1 Seropositive and HSV-1/2 Seronegative Persons

The purpose of this study is to look at the effect of daily herpes medication, valacyclovir
on HIV levels in the blood in persons who do not have genital herpes. This will help better
understand the effect that valacyclovir plays in the spread of HIV and the potential role
for HIV treatment in decreasing the HIV spread.

A total of 20 individuals who are HIV-1 seropositive and HSV-1/2 seronegative will be
recruited for the study. Participants must not be on antiretroviral therapy and must not be
planning to initiate HIV antiretroviral therapy during the study.

Participants will be asked to come to the clinic for a total of 16 visits over the course of
10 weeks. Participants will receive valacyclovir 1000 mg three times daily for 6 weeks.
During the first week, participants will return to the clinic for a total of 2 visits and
will provide plasma samples for baseline HIV-1 levels. During the second week,
participants will return to the clinic for a total 5 visits. At Visit 3, participants will
be provided the study medication. After drug initiation, participants will be asked to
return to the clinic within 6 hours and then again at Day 1, 2, and 3 post first dose.
During weeks 3-8, participants will be instructed to take valacyclovir and return to the
clinic for one follow-up visit each week to provide plasma samples for HIV-1 detection.

Participants will be asked to return to the clinic for 3 follow-up visits after study drug
discontinuation to provide plasma samples for HIV-1 detection.

Participants will be asked to complete a daily symptom and medication diary. All supplies
and study medical will be provided.

This is an outpatient study.

Inclusion Criteria:

- > 18 years old

- HIV-1 seropositive

- CD4 count>250 cell/mm3

- Detectable HIV-1 plasma viral load

- HSV-1 & 2 seronegative.

- Not on HIV antiretroviral therapy or planning to initiate antiretroviral therapy
during the study period.

- Not intending to move out of the area for duration of study participation

- Willing and able to provide independent written informed consent.

- Willing and able to undergo clinical evaluations.

- Willing and able to take study drug as directed.

- Willing and able to adhere to follow-up schedule

Exclusion Criteria:

- Known history of adverse reaction to acyclovir, valacyclovir, or famciclovir.

- Use of ganciclovir, foscarnet, or cidofovir

- History of evidence of CMV disease

- Known medical history of seizures

- Known renal insufficiency, defined as serum creatine >1.5 mg/dl

- AST or ALT >3times upper limit of normal

- Hematocrit <30%

- Neutropenia, defined as absolute neutrophil count <1000

- Thrombocytopenia, defined as platelet count <75,000

- History of thrombotic microangiopathy

- For women, pregnancy as confirmed by a urine pregnancy test

- Any other condition which, in the opinion of the principal investigator, may
compromise the ability to follow study procedures and complete the study