title: Herpes simplex virus type 2 and risk of intrapartum human immunodeficiency virus transmission.
abstract: OBJECTIVE
  To determine whether herpes simplex virus type 2 (HSV-2) infection was associated with risk of intrapartum human immunodeficiency virus type 1 (HIV-1) transmission and to define correlates of HSV-2 infection among HIV-1-seropositive pregnant women.
  
  
  METHODS
  We performed a nested case control study within a perinatal cohort in Nairobi, Kenya. Herpes simplex virus type 2 serostatus and the presence of genital ulcers were ascertained at 32 weeks of gestation. Maternal cervical and plasma HIV-1 RNA and cervical HSV DNA were measured at delivery.
  
  
  RESULTS
  One hundred fifty-two (87%) of 175 HIV-1-infected mothers were HSV-2-seropositive. Among the 152 HSV-2-seropositive women, nine (6%) had genital ulcers at 32 weeks of gestation, and 13 (9%) were shedding HSV in cervical secretions. Genital ulcers were associated with increased plasma HIV-1 RNA levels (P=.02) and an increased risk of intrapartum HIV-1 transmission (16% of transmitters versus 3% of nontransmitters had ulcers; P = .003), an association which was maintained in multivariable analysis adjusting for plasma HIV-1 RNA levels (P=.04). We found a borderline association for higher plasma HIV-1 RNA among women shedding HSV (P=.07) and no association between cervical HSV shedding and either cervical HIV-1 RNA levels or intrapartum HIV-1 transmission (P=.4 and P=.5, [corrected] respectively).
  
  
  CONCLUSIONS
  Herpes simplex virus type 2 is the leading cause of genital ulcers among women in sub-Saharan Africa and was highly prevalent in this cohort of pregnant women receiving prophylactic zidovudine. After adjusting for plasma HIV-1 RNA levels, genital ulcers were associated with increased risk of intrapartum HIV-1 transmission. These data suggest that management of HSV-2 during pregnancy may enhance mother-to-child HIV-1 prevention efforts.
  
  
  METHODS
  II.
authors.affiliation: Departments of Epidemiology and Medicine, University of Washington, Seattle, WA 98195, USA. adrake2@u.washington.edu
authors.forename: Alison L
authors.initials: AL
authors.lastname: Drake
authors.forename: Grace C
authors.initials: GC
authors.lastname: John-Stewart
authors.forename: Anna
authors.initials: A
authors.lastname: Wald
authors.forename: Dorothy A
authors.initials: DA
authors.lastname: Mbori-Ngacha
authors.forename: Rose
authors.initials: R
authors.lastname: Bosire
authors.forename: Dalton C
authors.initials: DC
authors.lastname: Wamalwa
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Lohman-Payne
authors.forename: Rhoda
authors.initials: R
authors.lastname: Ashley-Morrow
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
authors.forename: Carey
authors.initials: C
authors.lastname: Farquhar
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D004279:DNA, Viral / Q000378:metabolism; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000635:transmission*; D006558:Herpes Genitalis / Q000150:complications* / Q000175:diagnosis; D018258:Herpesvirus 2, Human / Q000235:genetics / Q000378:metabolism; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D007630:Kenya; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000209:etiology*; D012698:Serologic Tests
chemical_list: D004279:DNA, Viral