title: Herpes simplex virus type 2, genital ulcers and HIV-1 disease progression in postpartum women.
abstract: BACKGROUND
  Co-infection with herpes simplex virus type 2 (HSV-2) has been associated with increased HIV-1 RNA levels and immune activation, two predictors of HIV-1 progression. The impact of HSV-2 on clinical outcomes among HIV-1 infected pregnant women is unclear.
  
  
  METHODS
  HIV-1 infected pregnant women in Nairobi were enrolled antenatally and HSV-2 serology was obtained. HIV-1 RNA and CD4 count were serially measured for 12-24 months postpartum. Survival analysis using endpoints of death, opportunistic infection (OI), and CD4<200 cells µL, and linear mixed models estimating rate of change of HIV-1 RNA and CD4, were used to determine associations between HSV-2 serostatus and HIV-1 progression.
  
  
  RESULTS
  Among 296 women, 254 (86%) were HSV-2-seropositive. Only 30 (10%) women had prior or current genital ulcer disease (GUD); median baseline CD4 count was 422 cells µL. Adjusting for baseline CD4, women with GUD were significantly more likely to have incident OIs (adjusted hazard ratio (aHR) 2.79, 95% CI: 1.33-5.85), and there was a trend for association between HSV-2-seropositivity and incident OIs (aHR 3.83, 95% CI: 0.93-15.83). Rate of change in CD4 count and HIV-1 RNA did not differ by HSV-2 status or GUD, despite a trend toward higher baseline HIV-1 RNA in HSV-2-seropositive women (4.73 log10 copies/ml vs. 4.47 log10 copies/ml, P = 0.07).
  
  
  CONCLUSIONS
  HSV-2 was highly prevalent and pregnant HIV-1 infected women with GUD were significantly more likely to have incident OIs than women without GUD, suggesting that clinically evident HSV-2 is a more important predictor of HIV-1 disease progression than asymptomatic HSV-2.
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington, United States of America. aroxby@u.washington.edu
authors.forename: Alison C
authors.initials: AC
authors.lastname: Roxby
authors.forename: Alison L
authors.initials: AL
authors.lastname: Drake
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Brown
authors.forename: Daniel
authors.initials: D
authors.lastname: Matemo
authors.forename: Phelgona A
authors.initials: PA
authors.lastname: Otieno
authors.forename: Carey
authors.initials: C
authors.lastname: Farquhar
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000276:immunology; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000821:virology; D015497:HIV-1 / Q000502:physiology; D006558:Herpes Genitalis / Q000097:blood / Q000150:complications* / Q000821:virology; D018258:Herpesvirus 2, Human / Q000276:immunology / Q000502:physiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007630:Kenya; D009894:Opportunistic Infections / Q000097:blood / Q000150:complications; D049590:Postpartum Period; D011247:Pregnancy; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D014456:Ulcer / Q000097:blood / Q000150:complications* / Q000821:virology*; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral