title: Herpes simplex virus type 2 infection increases HIV incidence: a prospective study in rural Tanzania.
abstract: OBJECTIVE
  To quantify the association between prevalent or incident Herpes simplex virus type-2 (HSV2) infection and the incidence of HIV seroconversion among adults in the general population in rural Tanzania.
  
  
  METHODS
  Adults aged 15-54 years sampled randomly from 12 rural communities in Mwanza Region, Tanzania and recruited to a randomized trial of improved treatment of sexually transmitted diseases.
  
  
  METHODS
  Unmatched case-control study nested within trial cohort.
  
  
  METHODS
  Participants included 127 cases who seroconverted to HIV during the 2-year follow-up period and 636 randomly selected controls who remained HIV negative. Subjects were tested for HSV2 serology at baseline and follow-up, and associations between HIV and HSV2 were analysed with adjustment for socio-demographic and behavioural factors.
  
  
  RESULTS
  After adjusting for confounding factors, a strong association between HSV2 infection and HIV seroconversion was observed in men (test for trend: P < 0.001), with adjusted odds ratios (OR) of 6.12 [95% confidence interval (CI), 2.52-14.9] in those HSV2 positive at baseline, and 16.8 (95% CI, 6.06-46.3) in those acquiring HSV2 infection during follow-up. A weaker association was observed in women (tests for trend: P = 0.14), with adjusted OR of 1.32 (95% CI, 0.62-2.78) and 2.36 (95% CI, 0.81-6.84), respectively. Population attributable fractions of incident HIV infection due to HSV2 were estimated as 74% in men and 22% in women.
  
  
  CONCLUSIONS
  The results suggest that HSV2 plays an important role in the transmission of HIV infection in this population. There is an urgent need to identify effective HSV2 control measures in order to reduce HIV incidence in Africa.
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: María
authors.initials: M
authors.lastname: del Mar Pujades Rodríguez
authors.forename: Angela
authors.initials: A
authors.lastname: Obasi
authors.forename: Frank
authors.initials: F
authors.lastname: Mosha
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
authors.forename: David
authors.initials: D
authors.lastname: Brown
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.forename: David
authors.initials: D
authors.lastname: Mabey
authors.forename: David
authors.initials: D
authors.lastname: Ross
authors.forename: Heiner
authors.initials: H
authors.lastname: Grosskurth
authors.forename: Richard
authors.initials: R
authors.lastname: Hayes
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology* / Q000517:prevention & control; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology; D006558:Herpes Genitalis / Q000150:complications* / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012424:Rural Population; D012737:Sex Factors; D012725:Sexual Behavior; D013636:Tanzania / Q000453:epidemiology