Objectives:It is unclear whether the high HSV-2 prevalence found in much of Africa predates the HIV epidemic or is, to some extent, a consequence of it. We sought to assess HSV-2 prevalence trends in a rural African community over a period in which HIV prevalence rose sharply, and to explore antenatal clinic surveillance as a method of estimating community HSV-2 prevalence.
Methods: HSV-2 seroprevalence was determined among community controls seen for case-control studies of mycobacterial disease in Karonga District, Malawi 1988-90, 1998-2001 and 2002-5, and in women attending antenatal clinics (ANC) as part of surveillance for HIV in 1999-2000. Over this period HIV prevalence rose from 4% to 12%.
Results: HSV-2 prevalence in all periods increased sharply with age and was higher in women than in men. After adjusting for differences in sampling, there was no evidence of change in HSV-2 prevalence in the different periods. Women in the ANC had lower HSV-2 prevalence than those in the community, but the ANC prevalence was a good approximation to the combined male and female prevalence for the same age group.
Conclusions: This study suggests that HSV-2 was already widespread before the HIV epidemic and has not been greatly influenced by it. It also demonstrates that ANC surveillance may be useful for estimating community HSV-2 prevalence.