Effect of HIV-1 and antiretroviral therapy on herpes simplex virus type 2: a prospective study in African women.
OBJECTIVE
To document the natural history of herpes simplex virus type 2 (HSV-2) in relation to HIV and highly active antiretroviral therapy (HAART) in Africa, a longitudinal study was conducted of women in the placebo arms of two randomised controlled trials of HSV-suppressive therapy in Burkina Faso.


METHODS
22 HIV-uninfected women (group 1), 30 HIV-1-infected women taking HAART (group 2), and 68 HIV-1-infected women not eligible for HAART (group 3) were followed over 24 weeks. HSV-2 DNA was detected on alternate weeks using real-time PCR from cervicovaginal lavages. Plasma HIV-1 RNA was measured every month. CD4 cell counts were measured at enrollment.


RESULTS
Ulcers occurred on 1.9%, 3.1% and 7.2% of visits in groups 1, 2 and 3 (p = 0.02). Cervicovaginal HSV-2 DNA was detected in 45.5%, 63.3% and 67.6% of women (p = 0.11), and on 4.3%, 9.7% and 15.5% of visits in the three groups (p<0.001). Among HIV-infected women, cervicovaginal HSV-2 DNA was detected more frequently during ulcer episodes (adjusted risk ratio (aRR) 2.79, 95% CI 2.01 to 3.86) and less frequently among women practising vaginal douching (aRR 0.60, 95% CI 0.40 to 0.91). Compared with women not taking HAART and with CD4 cell counts of 500 cells/microl or greater, women on HAART had a similar risk of HSV-2 shedding (aRR 0.95, 95% CI 0.52 to 1.73), whereas women with CD4 cell counts of 200-500 cells/microl were more likely to shed HSV-2 (aRR 1.71, 95% CI 1.02 to 2.86).


CONCLUSIONS
HSV-2 reactivations occur more frequently among HIV-infected women, particularly those with low CD4 cell counts, and are only partly reduced by HAART. HSV therapy may benefit HIV-infected individuals during HAART.
Mayaud
P
P
Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E7HT, UK. philippe.mayaud@lshtm.ac.uk
Nagot
N
N
Konaté
I
I
Ouedraogo
A
A
Weiss
H A
HA
Foulongne
V
V
Defer
M-C
MC
Sawadogo
A
A
Segondy
M
M
Van de Perre
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D002050:Burkina Faso / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1; D006558:Herpes Genitalis / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D018258:Herpesvirus 2, Human; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D002577:Uterine Cervical Diseases / Q000453:epidemiology / Q000821:virology; D014623:Vaginal Diseases / Q000453:epidemiology / Q000821:virology; D017201:Virus Shedding