Incident HIV and herpes simplex virus type 2 infection among men in Rakai, Uganda.
OBJECTIVE
Herpes simplex virus type 2 (HSV-2) infection is associated with an increased risk for acquiring HIV, but little is known about the temporal sequence of these infections.


METHODS
: Six thousand three hundred ninety-six men were evaluated for serologic HSV-2 and HIV infections and behaviors during a male circumcision trial in Rakai, Uganda.


METHODS
HIV and HSV-2 status were determined using enzyme-linked immunosorbent assays and confirmed by HIV-1 and HSV-2 western blots. A Poisson multivariable model was used to estimate adjusted incidence rate ratios of HIV acquisition associated with HSV-2 and other covariates.


RESULTS
HIV incidence was 1.09/100 person-years and acquisition was associated with incident HSV-2 infection [adjusted incidence rate ratio (adjIRR) 5.28, 95% confidence interval (CI) 2.79-9.98], chronic HSV-2 infection (adjIRR 2.78, 95% CI 1.64-5.68), genital ulcer disease, urethral discharge, genital washing after intercourse, being unmarried, and being uncircumcised. Sixteen men acquired both HIV and HSV-2 during the trial: four acquired HIV first, three acquired HSV-2 first, and nine acquired both infections in the same follow-up interval.


CONCLUSIONS
The findings suggest that unsafe sex places men at risk of both HIV and HSV-2 infections, and it is unclear whether HSV-2 acquisition is a cofactor for HIV infection or a marker of correlated sexual exposures. This reinforces the need for promotion of safe sex as the primary method of prevention of both viruses.
Tobian
Aaron A R
AA
Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Ssempijja
Victor
V
Kigozi
Godfrey
G
Oliver
Amy E
AE
Serwadda
David
D
Makumbi
Frederick
F
Nalugoda
Frederick K
FK
Iga
Boaz
B
Reynolds
Steven J
SJ
Wawer
Maria J
MJ
Quinn
Thomas C
TC
Gray
Ronald H
RH
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D002944:Circumcision, Male; D004812:Epidemiologic Methods; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006558:Herpes Genitalis / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged; D014454:Uganda / Q000453:epidemiology; D047568:Unsafe Sex; D055815:Young Adult