Maternal herpes simplex virus type 2 coinfection increases the risk of perinatal HIV transmission: possibility to further decrease transmission?
OBJECTIVE
To evaluate the association between maternal herpes simplex virus type 2 seropositivity and genital herpes simplex virus type 2 shedding with perinatal HIV transmission.


METHODS
Evaluation of women who participated in a 1996-1997 perinatal HIV transmission prevention trial in Thailand.


METHODS
In this nonbreastfeeding population, women were randomized to zidovudine or placebo from 36 weeks gestation through delivery; maternal plasma and cervicovaginal HIV viral load and infant HIV status were determined for the original study. Stored maternal plasma and cervicovaginal samples were tested for herpes simplex virus type 2 antibodies by enzyme-linked immunoassay and for herpes simplex virus type 2 DNA by real-time PCR, respectively.


RESULTS
Among 307 HIV-positive women with available samples, 228 (74.3%) were herpes simplex virus type 2 seropositive and 24 (7.8%) were shedding herpes simplex virus type 2. Herpes simplex virus type 2 seropositivity was associated with overall perinatal HIV transmission [adjusted odds ratio, 2.6; 95% confidence interval, 1.0-6.7)], and herpes simplex virus type 2 shedding was associated with intrapartum transmission (adjusted odds ratio, 2.9; 95% confidence interval, 1.0-8.5) independent of plasma and cervicovaginal HIV viral load, and zidovudine treatment. Median plasma HIV viral load was higher among herpes simplex virus type 2 shedders (4.2 vs. 4.1 log(10)copies/ml; P = 0.05), and more shedders had quantifiable levels of HIV in cervicovaginal samples, compared with women not shedding herpes simplex virus type 2 (62.5 vs. 34.3%; P = 0.005).


CONCLUSIONS
We found an increased risk of perinatal HIV transmission among herpes simplex virus type 2 seropositive women and an increased risk of intrapartum HIV transmission among women shedding herpes simplex virus type 2. These novel findings suggest that interventions to control herpes simplex virus type 2 infection could further reduce perinatal HIV transmission.
Thailand Ministry of Public Health, US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand. Lbollen@tuc.or.th
Liesbeth Jm
LJ
Bollen
Sara J
SJ
Whitehead
Philip A
PA
Mock
Wanna
W
Leelawiwat
Suvanna
S
Asavapiriyanont
Amphan
A
Chalermchockchareonkit
Nirun
N
Vanprapar
Tawee
T
Chotpitayasunondh
Janet M
JM
McNicholl
Jordan W
JW
Tappero
Nathan
N
Shaffer
Rutt
R
Chuachoowong
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000032:analysis; D002584:Cervix Uteri / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000635:transmission*; D015497:HIV-1; D006558:Herpes Genitalis / Q000150:complications / Q000635:transmission*; D018258:Herpesvirus 2, Human / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control / Q000821:virology*; D014621:Vagina / Q000821:virology; D019562:Viral Load; D017201:Virus Shedding / Q000502:physiology; D015215:Zidovudine / Q000627:therapeutic use
D019380:Anti-HIV Agents; D000914:Antibodies, Viral; D004279:DNA, Viral; D015215:Zidovudine