title: Association of genital shedding of herpes simplex virus type 2 and HIV-1 among sex workers in rural Zimbabwe.
abstract: BACKGROUND
  Herpes simplex virus type 2 (HSV-2) facilitates sexual acquisition of HIV-1 but data on transmission are less clear. In this study the interaction between genital shedding of HIV-1 and HSV-2 was explored among Zimbabwean sex workers.
  
  
  METHODS
  Women (n = 214) were interviewed about genital symptoms. Blood samples were analysed for HIV-1 and HSV-2 antibodies, HIV-1 plasma viral load (PVL) and CD4 lymphocyte count and genital swabs for detection of HIV-1 and HSV-2 genital shedding, Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis, and a cervico-vaginal lavage (CVL) for quantitative measurement of HIV-1 shedding. Shedding analyses were undertaken on women co-infected with HSV-2 and HIV-1.
  
  
  RESULTS
  A total of 124 women were co-infected with HIV-1 and HSV-2; 58 were infected with HSV-2 alone. Most HIV-1-infected women were co-infected with HSV-2 (95.4%). Genital HIV-1 shedding was detected in 84.3% of co-infected women and was associated with low CD4 cell count and high PVL but not with reported symptoms of genital herpes or genital shedding of HSV-2. There was no difference in HIV-1 shedding among women shedding HSV-2 (79.3%) and women not shedding HSV-2 (83.2%) (P = 0.64). The adjusted odds ratio for HIV-1 shedding between HSV-2 shedders and non-shedders was 0.8 [95% confidence interval (CI), 0.2-3.3]. HIV-1 PVL(log10) and CVL viral load(log10) were correlated (r = 0.38; 95%CI, 0.2-0.5). After adjusting for PVL, genital symptoms and age, HSV-2 shedding had no effect on CVL viral load (P = 0.13).
  
  
  CONCLUSIONS
  Rate and quantity of HIV-1 genital shedding do not appear to be altered by presence of HSV-2 genital shedding.
authors.affiliation: Royal Free and University College Medical School, London, UK. frances@uz-ucsf.co.zw
authors.forename: Frances F
authors.initials: FF
authors.lastname: Cowan
authors.forename: Sophie J S
authors.initials: SJ
authors.lastname: Pascoe
authors.forename: Katrina L
authors.initials: KL
authors.lastname: Barlow
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Langhaug
authors.forename: Shabbar
authors.initials: S
authors.lastname: Jaffar
authors.forename: John W
authors.initials: JW
authors.lastname: Hargrove
authors.forename: Noah J
authors.initials: NJ
authors.lastname: Robinson
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Latif
authors.forename: Mary T
authors.initials: MT
authors.lastname: Bassett
authors.forename: David
authors.initials: D
authors.lastname: Wilson
authors.forename: David W G
authors.initials: DW
authors.lastname: Brown
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hayes
mesh_terms: D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D005836:Genitalia, Female / Q000821:virology*; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000635:transmission / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006558:Herpes Genitalis / Q000150:complications / Q000453:epidemiology / Q000635:transmission / Q000821:virology; D018258:Herpesvirus 2, Human / Q000302:isolation & purification*; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data; D011477:Sex Work; D019562:Viral Load; D017201:Virus Shedding; D015030:Zimbabwe / Q000453:epidemiology