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Herpesviruses as Co-Factors of HIV Disease: Case not Proven

Factors other than human immunodeficiency virus (HIV) may be important in determining disease progression in AIDS. The concept that viruses may act as co-factors in HIV pathogenesis has been based on in vitro studies of potential molecular or biological interactions between HIV and other viruses, some epidemiological evidence for an adverse effect of cytomegalovirus on progression to AIDS, and the apparent survival advantage conferred by aciclovir prophylaxis in people with AIDS. It is possible that molecular or cellular interaction between herpesviruses or other infectious agents and HIV are necessary to encourage the virus into maximal production or to amplify pre-existing replication. However, there is no evidence as yet that this occurs, and studies that claim to show such an effect cannot be convincing unless they take account of the significant associations of progression with virus phenotype, host response, age and genetic factors. This paper was presented as the case against in a debate on ‘Herpesviruses as co-factors of HIV disease’. The case for was made by Paul Griffiths (see page 17)