Herpes simplex virus infection in women in the WIHS: epidemiology and effect of antiretroviral therapy on clinical manifestations.
OBJECTIVE
To determine the prevalence of infection with herpes simplex virus types 1 (HSV-1) and 2 (HSV-2) among women with and at high risk for HIV infection, and to evaluate the effect of HAART on the recurrence of genital lesions.


METHODS
We evaluated the epidemiology and clinical manifestations associated with HSV-1 and HSV-2 among 1796 HIV-infected and 476 HIV-uninfected women enrolled in a multisite cohort study. Serum antibodies to HSV-1 and HSV-2 at baseline and self-reported history of genital herpes, reports of recent genital sores and presence of genital ulcers on examination, and use of HAART regimen at each study visit were analyzed.


RESULTS
Reactivity to HSV-1 only and HSV-2 only was detected in 18% and 20% of HIV-infected, and in 28% and 18% of HIV-uninfected participants respectively; 58% of HIV-infected women and 45% of HIV-uninfected women were seropositive for both HSV types. Reactivity to HSV-2 was associated with increasing age, more male sexual partners, earlier sexual debut, African-American race, Latina ethnicity, less education and lower income. HIV-uninfected women reported significantly fewer genital sores than HIV-infected women who had used HAART for at least 1 year and had optimal CD4 cell gain and viral suppression (adjusted odds ratio (OR), 0.19; 95% confidence interval (CI), 0.13-0.28).


CONCLUSIONS
Use of HAART and subsequent immune recovery does not completely eliminate the effect of HIV infection on genital lesions among women with concurrent HSV-2 infection.
Ameli
Niloufar
N
Department of Medicine, Division of Infectious Diseases, University of California-San Francisco School of Medicine, San Francisco, CA 94143, USA. niloufar.ameli@ucsf.edu
Bacchetti
Peter
P
Morrow
Rhoda Ashley
RA
Hessol
Nancy A
NA
Wilkin
Timothy
T
Young
Mary
M
Cohen
Mardge
M
Minkoff
Howard
H
Gange
Stephen J
SJ
Greenblatt
Ruth M
RM
D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000208:ethnology; D015497:HIV-1 / Q000276:immunology*; D006558:Herpes Genitalis / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology; D018259:Herpesvirus 1, Human / Q000276:immunology; D018258:Herpesvirus 2, Human / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012725:Sexual Behavior; D012747:Sexual Partners; D012959:Socioeconomic Factors; D014456:Ulcer / Q000453:epidemiology / Q000208:ethnology / Q000276:immunology; D014481:United States / Q000453:epidemiology
D000914:Antibodies, Viral