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Date Posted: 20:09:17 07/24/02 Wed
Author: moonotter
Subject: HSV-2 Significantly Increases Risk of HIV Infection

HSV-2 Significantly Increases Risk of HIV Infection


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


By Deborah Mitchell
BARCELONA, Spain (Reuters Health) Jul 08 - There is a strong link between herpes simplex virus 2 (HSV-2) infection and increased risk of HIV infection, according to the results of two studies reported on Monday at the XIV International AIDS Conference.

"HSV-2 infection is the silent enemy in the HIV epidemic," Dr. Steven J. Reynolds of Johns Hopkins University in Baltimore told conference participants on Monday. Although a number of studies have identified genital ulcer disease as a major risk factor for HIV infection, few have looked at the impact of acute HSV-2 infection on HIV acquisition, he explained.

In his study, Dr. Reynolds, of Johns Hopkins University in Baltimore, and colleagues at the National AIDS Research Institute in Pune, India, looked at the effect of incident HSV-2 infection as a risk factor for HIV transmission.

The retrospective cohort included 2732 HIV-seronegative patients attending one of three sexually transmitted disease clinics in Pune between 1993 and 2000. At baseline, 1175 (43%) were HSV-2-infected.

Dr. Reynolds group found that the subsequent incidence of HIV infection was 5.8 per 100 person-years. After adjusting for known HIV risk factors, the relative risk of HIV infection associated with chronic HSV-2 infection was 1.69. The RR of HIV infection associated with remote primary HSV-2 infection was 1.81.

"Recent HSV-2 infection was independently associated with a 3.64-fold increased risk of primary HIV infection" (p<0.001), the investigators report.

In a second study, researchers led by Dr. A. Kamali of the Medical Research Council, Entebbe, Uganda, also observed a strong association between HSV-2 infection and HIV risk.

Dr. Kamali's group evaluated approximately 20,000 adults enrolled in a community-randomized trial in Uganda that aimed to improve rates of STDs and behavioral factors to reduce HIV transmission rates.

Overall, the researchers found that HSV-2 prevalence was significantly higher among HIV-positive patients (80%) than among HIV-negative patients (23%). The incidence of HSV-2 per 100 person-years was also significantly higher among HIV-positive (15.7) than among HIV-negative (3.0) patients (p<0.001 for both measures).

Based on these findings, "I think there is a need for HSV-2 treatment to reduce the incidence of HIV" in this population, Dr. Kamali concluded.

The HSV-2 prevalence is high in developing countries, "but among certain groups in the US it's very high as well," Dr. Reynolds told Reuters Health. Although the overall HSV-2 prevalence in the US is about 20%, the prevalence in the gay/bisexual community is comparable to that in developing countries. "And most people with HSV-2 don't know their serostatus," he added.

"There is an interaction between the two viruses," Dr. Reynolds continued. "And it's a complex interaction, with many factors involved."

Some studies have shown that "in recurrent herpes, there's an influx of CD4 cells...that may facilitate HIV infection," he said. "And in cells that are infected with both viruses, the replication of HIV is much more rapid. So that may also affect the ability of HIV acquisition."

"If we could get an [HSV-2] vaccine that was effective and target it at a high-risk population, we may have an impact on HIV rates," said Dr. Reynolds. But so far, "there hasn't been a vaccine yet that's been shown to be effective." To reduce HIV transmission, an HSV vaccine would have to be at least 80% effective, he added.

However, there is an ongoing trial in which subjects are receiving herpes simplex treatment with acyclovir in an effort to reduce the rates of HIV transmission.



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