Incident and prevalent herpes simplex virus type 2 infection increases risk of HIV acquisition among women in Uganda and Zimbabwe.
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.
Brown
Joelle M
JM
Department of Epidemiology, University of California at Los Angeles, 10880 Wilshire Boulevard, Los Angeles, CA 90095, USA. joellebrown@ucla.edu
Wald
Anna
A
Hubbard
Alan
A
Rungruengthanakit
Kittipong
K
Chipato
Tsungai
T
Rugpao
Sungwal
S
Mmiro
Francis
F
Celentano
David D
DD
Salata
Robert S
RS
Morrison
Charles S
CS
Richardson
Barbra A
BA
Padian
Nancy S
NS
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