Objectives: To document the natural history of herpes simplex virus type-2 (HSV-2) in relation to HIV and HAART in Africa, we conducted a longitudinal study 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 cervico-vaginal lavages. Plasma HIV-1 RNA was measured every month. CD4 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). Cervico-vaginal 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, cervico-vaginal HSV-2 DNA was detected more frequently during ulcer episodes (adjusted risk ratio [aRR] 2.79, 95% confidence interval [CI] 2.01-3.86) and less frequently among women practising vaginal douching (aRR 0.60, 95%CI 0.40-0.91). Compared with women not taking HAART and with CD4 count >500 cells/µL, women on HAART had a similar risk of HSV-2 shedding (aRR 0.95, 95%CI 0.52-1.73), whilst women with CD4 count 200-500 cells/µL were more likely to shed HSV-2 (aRR 1.71, 95%CI 1.02-2.86).
Conclusions: HSV-2 reactivations occur more frequently among HIV-infected women, particularly those with low CD4 counts, and are only partially reduced by HAART. HSV therapy may benefit HIV-infected individuals during HAART.