title: HIV-1/HSV-2 co-infected adults in early HIV-1 infection have elevated CD4+ T cell counts.
abstract: BACKGROUND
  HIV-1 is often acquired in the presence of pre-existing co-infections, such as Herpes Simplex Virus 2 (HSV-2). We examined the impact of HSV-2 status at the time of HIV-1 acquisition for its impact on subsequent clinical course, and total CD4+ T cell phenotypes.
  
  
  METHODS
  We assessed the relationship of HSV-1/HSV-2 co-infection status on CD4+ T cell counts and HIV-1 RNA levels over time prior in a cohort of 186 treatment naïve adults identified during early HIV-1 infection. We assessed the activation and differentiation state of total CD4+ T cells at study entry by HSV-2 status.
  
  
  RESULTS
  Of 186 recently HIV-1 infected persons, 101 (54%) were sero-positive for HSV-2. There was no difference in initial CD8+ T cell count, or differences between the groups for age, gender, or race based on HSV-2 status. Persons with HIV-1/HSV-2 co-infection sustained higher CD4+ T cell counts over time (+69 cells/ul greater (SD = 33.7, p = 0.04) than those with HIV-1 infection alone (Figure 1), after adjustment for HIV-1 RNA levels (-57 cells per 1 log(10) higher HIV-1 RNA, p<0.0001). We did not observe a relationship between HSV-2 infection status with plasma HIV-1 RNA levels over time. HSV-2 acquisition after HIV-1 acquisition had no impact on CD4+ count or viral load. We did not detect differences in CD4+ T cell activation or differentiation state by HSV-2+ status.
  
  
  CONCLUSIONS
  We observed no effect of HSV-2 status on viral load. However, we did observe that treatment naïve, recently HIV-1 infected adults co-infected with HSV-2+ at the time of HIV-1 acquisition had higher CD4+ T cell counts over time. If verified in other cohorts, this result poses a striking paradox, and its public health implications are not immediately clear.
authors.affiliation: HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Barbour
authors.forename: Mariana M
authors.initials: MM
authors.lastname: Sauer
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Sharp
authors.forename: Keith E
authors.initials: KE
authors.lastname: Garrison
authors.forename: Brian R
authors.initials: BR
authors.lastname: Long
authors.forename: Helena
authors.initials: H
authors.lastname: Tomiyama
authors.forename: Katia C
authors.initials: KC
authors.lastname: Bassichetto
authors.forename: Solange M
authors.initials: SM
authors.lastname: Oliveira
authors.forename: Maria C
authors.initials: MC
authors.lastname: Abbate
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Nixon
authors.forename: Esper G
authors.initials: EG
authors.lastname: Kallas
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology* / Q000276:immunology; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000150:complications* / Q000378:metabolism*; D015497:HIV-1 / Q000378:metabolism*; D006561:Herpes Simplex / Q000097:blood* / Q000150:complications*; D018258:Herpesvirus 2, Human / Q000378:metabolism*; D006801:Humans; D007249:Inflammation; D008297:Male; D008954:Models, Biological; D010641:Phenotype; D012367:RNA, Viral / Q000378:metabolism; D019562:Viral Load
chemical_list: D012367:RNA, Viral