Herpes simplex virus type 2: a key role in HIV incidence
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Date
2009
Journal Title
Journal ISSN
Volume Title
Publisher
Aids
Abstract
Many epidemiological studies have found a strong association between HSV-2 infection and HIV infection, including longitudinal studies in which it was known that the HSV-2 infection preceded the HIV infection [1]. However, two recent trials of suppressive therapy of HSV-2 with acyclovir (400 mg b.i.d) showed no reduction in HIV incidence [2,3]. Although this may simply reflect the difficulty of adequately suppressing HSV-2 reactivations with the drug regimen used, the results have led some to challenge the importance of HSV-2 infection as a risk factor for HIV [4].
In this issue, Tobian et al.[5] use data from the Rakai male circumcision trial to assess the effect of prevalent and incident HSV-2 infection on HIV incidence. They found that prevalent HSV-2 infection increased HIV incidence three-fold, and that men who acquired HSV-2 during follow-up had a six-fold risk of HIV incidence, in analyses adjusted for sexual behaviour.
These results are very similar to those found in a systematic review [1]. This included cohort and nested case–control studies up to 2004, and identified 18 that were adjusted for age and sexual behaviour. We have re-run the meta-analysis including more recent studies that fit the same criteria (Fig. 1). Six additional studies, as well as that by Tobian et al.[5], are included: one in men from the circumcision trial in South Africa [6]; two in women in the general population, in Uganda and Zimbabwe [7]; two in female sex workers in Kenya [8] and Tanzania [9]; and one in men who have sex with men (MSM) in the US [10]. Summary estimates of the relative risk (RR) show a strong and consistent association of prevalent HSV-2 and incident HIV after adjusting for age and measures of sexual behaviour [RRwomen = 3.4, 95% confidence interval (CI) 2.4–4.8; RRmen = 2.8, 2.1–3.7; RRsex workers = 1.5, 0.75–3.0; RRMSM = 1.6, 1.2–2.0). In addition, a cohort study in Uganda found an adjusted rate ratio of 8.7 (1.1–67.2) for men and women combined
Description
Keywords
herpes simplex virus type 2, HIV, incidence
Citation
Glynn, J. R., Biraro, S., & Weiss, H. A. (2009). Herpes simplex virus type 2: a key role in HIV incidence. Aids, 23(12), 1595-1598. doi: 10.1097/QAD.0b013e32832e15e8