The effects of herpes simplex virus-2 on HIV-1 acquisition and transmission: a review of two overlapping epidemics.
Increasing evidence demonstrates a substantial link between the epidemics of sexually transmitted HIV-1 and herpes simplex virus (HSV)-2 infection. More than 30 epidemiologic studies have demonstrated that prevalent HSV-2 is associated with a 2- to 4-fold increased risk of HIV-1 acquisition. Per-sexual contact transmission rates among couples from Rakai, Uganda indicate that at all levels of plasma HIV-1 RNA in the source partner, HSV-2-seropositive HIV-1-susceptible persons have a 5-fold greater risk of acquiring HIV-1 compared with HSV-2-negative persons. In vitro and in vivo studies suggest that mucosal HIV-1 shedding is more frequent and in greater amounts during mucocutaneous HSV-2 replication, including subclinical mucosal reactivations. Most HIV-1-infected persons are coinfected with HSV-2, and most experience frequent subclinical and clinical reactivations of HSV-2. Subclinical HSV reactivation elevates serum HIV-1 RNA levels, and daily therapy with acyclovir appears to reduce plasma HIV-1 RNA. These data show that greater attention to the diagnosis and treatment of HSV-2 among HIV-1-infected persons is warranted, especially those who continue to be sexually active, those not on antiretroviral therapy, or those whose disease is not well suppressed by antiretrovirals.
Corey
Lawrence
L
Department of Medicine, University of Washington Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA. lcorey@u.washington.edu
Wald
Anna
A
Celum
Connie L
CL
Quinn
Thomas C
TC
D000212:Acyclovir / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood; D002986:Clinical Trials as Topic; D015897:Comorbidity; D018562:Disease Transmission, Infectious; D005260:Female; D014943:Global Health; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission; D015497:HIV-1 / Q000472:pathogenicity / Q000502:physiology; D006561:Herpes Simplex / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission; D018258:Herpesvirus 2, Human / Q000276:immunology / Q000502:physiology; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D019562:Viral Load; D014774:Virulence; D014779:Virus Replication
D000914:Antibodies, Viral; D000212:Acyclovir