CLINICAL

Effect of HIV-1 and antiretroviral therapy on herpes simplex virus type 2: a prospective study in African women

P Mayaud¹, N Nagot^1,3,4, I Konaté³, A Ouedraogo³, H A Weiss², V Foulongne⁴, M-C Defer³, A Sawadogo⁵, M Segondy⁴, P Van de Perre⁴ and on behalf of the ANRS 1285 Study Group

¹ Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
² Infectious Diseases Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
³ Centre Muraz, Bobo-Dioulasso, Burkina Faso
⁴ Université Montpellier 1, EA 4205 "Transmission, Pathogenèse et Prévention de l’Infection par le VIH", and Laboratoire de Bactériologie-Virologie and Département d’Information Médicale, CHU Montpellier, Montpellier, France
⁵ University Hospital of Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso

Correspondence to:
Dr P Mayaud, Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; philippe.mayaud{at}lshtm.ac.uk

Objectives: To document the natural history of herpes simplex virus type 2 (HSV-2) in relation to HIV and highly active antiretroviral therapy (HAART) in Africa, a longitudinal study was conducted of women in the placebo arms of two randomised controlled trials of HSV-suppressive therapy in Burkina Faso.

Methods: 22 HIV-uninfected women (group 1), 30 HIV-1-infected women taking HAART (group 2), and 68 HIV-1-infected women not eligible for HAART (group 3) were followed over 24 weeks. HSV-2 DNA was detected on alternate weeks using real-time PCR from cervicovaginal lavages. Plasma HIV-1 RNA was measured every month. CD4 cell counts were measured at enrolment.

Results: Ulcers occurred on 1.9%, 3.1% and 7.2% of visits in groups 1, 2 and 3 (p = 0.02). Cervicovaginal HSV-2 DNA was detected in 45.5%, 63.3% and 67.6% of women (p = 0.11), and on 4.3%, 9.7% and 15.5% of visits in the three groups (p<0.001). Among HIV-infected women, cervicovaginal HSV-2 DNA was detected more frequently during ulcer episodes (adjusted risk ratio (aRR) 2.79, 95% CI 2.01 to 3.86) and less frequently among women practising vaginal douching (aRR 0.60, 95% CI 0.40 to 0.91). Compared with women not taking HAART and with CD4 cell counts of 500 cells/µl or greater, women on HAART had a similar risk of HSV-2 shedding (aRR 0.95, 95% CI 0.52 to 1.73), whereas women with CD4 cell counts of 200–500 cells/µl were more likely to shed HSV-2 (aRR 1.71, 95% CI 1.02 to 2.86).

Conclusions: HSV-2 reactivations occur more frequently among HIV-infected women, particularly those with low CD4 cell counts, and are only partly reduced by HAART. HSV therapy may benefit HIV-infected individuals during HAART.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Brief encounters

Helen Ward and Rob Miller
Sex Transm Inf 2008 84: 329. [Extract] [Full Text] [PDF]