title: Effect of genital herpes on cervicovaginal HIV shedding in women co-infected with HIV AND HSV-2 in Tanzania.
abstract: OBJECTIVE
  To compare the presence and quantity of cervicovaginal HIV among HIV seropositive women with clinical herpes, subclinical HSV-2 infection and without HSV-2 infection respectively; to evaluate the association between cervicovaginal HIV and HSV shedding; and identify factors associated with quantity of cervicovaginal HIV.
  
  
  METHODS
  Four groups of HIV seropositive adult female barworkers were identified and examined at three-monthly intervals between October 2000 and March 2003 in Mbeya, Tanzania: (1) 57 women at 70 clinic visits with clinical genital herpes; (2) 39 of the same women at 46 clinic visits when asymptomatic; (3) 55 HSV-2 seropositive women at 60 clinic visits who were never observed with herpetic lesions; (4) 18 HSV-2 seronegative women at 45 clinic visits. Associations of genital HIV shedding with HIV plasma viral load (PVL), herpetic lesions, HSV shedding and other factors were examined.
  
  
  RESULTS
  Prevalence of detectable genital HIV RNA varied from 73% in HSV-2 seronegative women to 94% in women with herpetic lesions (geometric means 1634 vs 3339 copies/ml, p = 0.03). In paired specimens from HSV-2 positive women, genital HIV viral shedding was similar during symptomatic and asymptomatic visits. On multivariate regression, genital HIV RNA (log10 copies/mL) was closely associated with HIV PVL (β = 0.51 per log10 copies/ml increase, 95%CI:0.41-0.60, p<0.001) and HSV shedding (β = 0.24 per log10 copies/ml increase, 95% CI:0.16-0.32, p<0.001) but not the presence of herpetic lesions (β = -0.10, 95%CI:-0.28-0.08, p = 0.27).
  
  
  CONCLUSIONS
  HIV PVL and HSV shedding were more important determinants of genital HIV than the presence of herpetic lesions. These data support a role of HSV-2 infection in enhancing HIV transmissibility.
authors.affiliation: Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom. jim.todd@lshtm.ac.uk
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
authors.forename: Gabriele
authors.initials: G
authors.lastname: Riedner
authors.forename: Leonard
authors.initials: L
authors.lastname: Maboko
authors.forename: Michael
authors.initials: M
authors.lastname: Hoelscher
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
authors.forename: Eligius
authors.initials: E
authors.lastname: Lyamuya
authors.forename: David
authors.initials: D
authors.lastname: Mabey
authors.forename: Mary
authors.initials: M
authors.lastname: Rusizoka
authors.forename: Laurent
authors.initials: L
authors.lastname: Belec
authors.forename: Richard
authors.initials: R
authors.lastname: Hayes
mesh_terms: D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology; D006558:Herpes Genitalis / Q000453:epidemiology* / Q000821:virology; D018258:Herpesvirus 2, Human / Q000472:pathogenicity*; D006801:Humans; D012367:RNA, Viral / Q000235:genetics; D013636:Tanzania; D017201:Virus Shedding / Q000502:physiology; D055815:Young Adult
chemical_list: D012367:RNA, Viral; C052835:adenovirus associated RNA