title: Incident and prevalent herpes simplex virus type 2 infection increases risk of HIV acquisition among women in Uganda and Zimbabwe.
abstract: BACKGROUND
  An association has been demonstrated between herpes simplex type 2 (HSV-2) and HIV infection among men, but prospective studies in women have yielded mixed results.
  
  
  OBJECTIVE
  To estimate the effects of prevalent and incident HSV-2 infection on subsequent HIV acquisition among women in two African countries.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  HSV-2 and HIV serostatus were evaluated at enrollment and quarterly for 15-24 months among 4531 sexually active, HIV-uninfected women aged 18-35 years from Uganda and Zimbabwe. The association between prior HSV-2 infection and HIV acquisition was estimated using a marginal structural discrete survival model, adjusted for covariates.
  
  
  RESULTS
  HSV-2 seroprevalence at enrollment was 52% in Uganda and 53% in Zimbabwe; seroincidence during follow-up was 9.6 and 8.8/100 person-years in Uganda and Zimbabwe, respectively. In Uganda, the hazard ratio (HR) for HIV was 2.8 [95% confidence interval (CI), 1.5-5.3] among women with seroprevalent HSV-2 and 4.6 (95% CI, 1.6-13.1) among women with seroincident HSV-2, adjusted for confounding. In Zimbabwe, the HR for HIV was 4.4 (95% CI, 2.7-7.2) among women with seroprevalent HSV-2, and 8.6 (95% CI, 4.3-17.1) among women with seroincident HSV-2, adjusted for confounding. The population attributable risk percent for HIV due to prevalent and incident HSV-2 infection was 42% in Uganda and 65% in Zimbabwe.
  
  
  CONCLUSIONS
  HSV-2 plays an important role in the acquisition of HIV among women. Efforts to implement known HSV-2 control measures, as well as identify additional measures to control HSV-2, are urgently needed to curb the spread of HIV.
authors.affiliation: Department of Epidemiology, University of California at Los Angeles, 10880 Wilshire Boulevard, Los Angeles, CA 90095, USA. joellebrown@ucla.edu
authors.forename: Joelle M
authors.initials: JM
authors.lastname: Brown
authors.forename: Anna
authors.initials: A
authors.lastname: Wald
authors.forename: Alan
authors.initials: A
authors.lastname: Hubbard
authors.forename: Kittipong
authors.initials: K
authors.lastname: Rungruengthanakit
authors.forename: Tsungai
authors.initials: T
authors.lastname: Chipato
authors.forename: Sungwal
authors.initials: S
authors.lastname: Rugpao
authors.forename: Francis
authors.initials: F
authors.lastname: Mmiro
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano
authors.forename: Robert S
authors.initials: RS
authors.lastname: Salata
authors.forename: Charles S
authors.initials: CS
authors.lastname: Morrison
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Padian
mesh_terms: D000293:Adolescent; D000328:Adult; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission / Q000821:virology*; D006558:Herpes Genitalis / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D012725:Sexual Behavior; D014454:Uganda / Q000453:epidemiology; D015030:Zimbabwe / Q000453:epidemiology