title: The role of herpes simplex virus type 2 and other genital infections in the acquisition of HIV-1 among high-risk women in northern Tanzania.
abstract: BACKGROUND
  We examined the role of herpes simplex virus type 2 (HSV-2) and other genital infections on human immunodeficiency virus type 1 (HIV-1) incidence in a cohort study conducted between 2002 and 2005 among female bar/hotel workers in Moshi, Tanzania.
  
  
  METHODS
  At baseline and every 3 months thereafter, participants were interviewed, and blood and genital samples were collected. Predictors of HIV-1 incidence were evaluated using a Cox proportional hazards regression model.
  
  
  RESULTS
  Of 845 women who were HIV-1 seronegative at baseline, 689 (81.5%) were monitored in the study for a total of 698.6 person-years at risk (PYARs). The overall HIV-1 incidence was 4.6/100 PYARs (95% confidence interval [CI], 3.0-6.2/100 PYARs), and condom use was very low. After adjustment for other risk factors, the risk of HIV-1 was increased among women with HSV-2 at baseline (hazard ratio [HR], 4.3 [95% CI, 1.5-12.4]) and in those who acquired HSV-2 during the study period (HR, 5.5 [95% CI, 1.2-25.4]). Other independent predictors of HIV-1 were baseline chlamydial infection (HR, 5.2), bacterial vaginosis (HR, 2.1), and the occurrence of genital ulcers (HR, 2.7).
  
  
  CONCLUSIONS
  HSV-2 and other genital infections were the most important risk factors for HIV-1. Control of these infections could help to reduce HIV-1 incidence in this population.
authors.affiliation: Department of Population and International Health, Harvard School of Public Health, Boston, MA 02115, USA. skapiga@hsph.harvard.edu
authors.forename: Saidi H
authors.initials: SH
authors.lastname: Kapiga
authors.forename: Noel E
authors.initials: NE
authors.lastname: Sam
authors.forename: Heejung
authors.initials: H
authors.lastname: Bang
authors.forename: Quanhong
authors.initials: Q
authors.lastname: Ni
authors.forename: Trong T H
authors.initials: TT
authors.lastname: Ao
authors.forename: Ireen
authors.initials: I
authors.lastname: Kiwelu
authors.forename: Sarah
authors.initials: S
authors.lastname: Chiduo
authors.forename: Uzodinma
authors.initials: U
authors.lastname: Ndibe
authors.forename: George
authors.initials: G
authors.lastname: Seage
authors.forename: Paul
authors.initials: P
authors.lastname: Coplan
authors.forename: John
authors.initials: J
authors.lastname: Shao
authors.forename: Zeda F
authors.initials: ZF
authors.lastname: Rosenberg
authors.forename: Max
authors.initials: M
authors.lastname: Essex
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D015497:HIV-1; D006561:Herpes Simplex / Q000097:blood / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D018258:Herpesvirus 2, Human; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology