RT Journal Article SR Electronic T1 P3.224 Effect of Herpes Simplex Virus Type 2 (HSV-2) Infection on Progression of HIV Infection Among Female Sex Workers in Burkina Faso JF Sexually Transmitted Infections JO Sex Transm Infect FD BMJ Publishing Group Ltd SP A218 OP A218 DO 10.1136/sextrans-2013-051184.0681 VO 89 IS Suppl 1 A1 I T Traore A1 I Konate A1 N Meda A1 W Bazie A1 M N Hema A1 A Kabore A1 D Kania A1 P Mayaud A1 P Van De Perre A1 N Nagot YR 2013 UL http://sti.bmj.com/content/89/Suppl_1/A218.2.abstract AB Background The effect of HSV-2 on the natural history of HIV-1 remains unclear. Although trials have shown a modest but significant impact of HSV-2 suppression on HIV-1 disease progression, the sub-optimal antiviral efficacy of aciclovir and its potential antiretroviral effect have limited our ability to measure the true effect of HSV-2 on HIV-1 disease progression. This study aimed to assess the effect of untreated HSV-2 infection on the time to ART. Methods From December 2003 to February 2012, HIV-1 infected female sex workers were enrolled in a prospective open cohort in Burkina Faso. At each 3-month follow-up visits, CD4 count and HIV-1 plasma viral load were done. Participants were offered care including ART and psychological support. Participants not on ART and having at least 350 CD4 cells/µl at enrolment (the current CD4 count threshold for ART initiation) were included in this analysis, which was censored at 36 months of follow-up when the assumption of proportional hazard was no longer met. Results Overall, 164 co-infected women and 20 HIV-1 mono-infected women were enrolled in this study. At enrollment, the only difference between the two groups was a younger age of HIV-1 mono-infected women (median age 24 versus 31 years, p < 0.001). In linear mixed models, the age-adjusted mean CD4 count at baseline (intercept) was significantly lower among HSV-2 positive women (–211 cell/µL, p < 0.001), but no difference in baseline CD4-adjusted plasma viral load was observed. During follow-up, 3 out 20 HIV-1 mono-infected women initiated ART versus 52 out of 164 HSV-2 co-infected women. After adjustment for baseline CD4 count and age, HSV-2 infected women were still much more likely to initiate ART over 36 months (HR = 4.6, CI 95%: 1.04–20.5, p = 0.04). Conclusion HIV-1 disease progression, as assessed by time to ART eligibility, was much accelerated for women co-infected with HSV-2.