title: Effect of HSV-2 on population-level trends in HIV incidence in Uganda between 1990 and 2007.
abstract: OBJECTIVE
  To assess the long-term effects of population-level HSV-2 infection on HIV incidence.
  
  
  METHODS
  Data from a population-based cohort in south-western Uganda were used to estimate HIV incidence from 1990 to 2007. Stored blood samples were tested for HSV-2, and the impact of HSV-2 prevalence and incidence on HIV incidence was estimated by calculating population attributable fractions (PAFs). The association between population-level annual HIV incidence and annual HSV-2 incidence/prevalence was analysed using linear regression.
  
  
  RESULTS
  HIV incidence declined over time among men, from 8.72/1000 person-years (pyr) in 1990 to 4.85/1000 pyr in 2007 (P-trend <0.001). In contrast, there was no decline in HIV incidence among women (4.86/1000 pyr in 1990 to 6.74/1000 pyr in 2007, P-trend = 0.18). PAFs of incident HIV attributable to HSV-2 were high (60% in males; 70% in females). There was no evidence of an association between long-term trends in HIV incidence and HSV-2 prevalence or incidence.
  
  
  CONCLUSIONS
  Assuming a causal relationship, a substantial proportion of new HIV infections in this population are attributable to HSV-2. The study did not find an effect of HSV-2 prevalence/incidence on trends in HIV incidence. HIV incidence did not vary much during the study period. This may partly explain the lack of association.
authors.affiliation: Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda; London School of Hygiene and Tropical Medicine, Medical Research Council Tropical Epidemiology Group, London, UK.
authors.forename: Samuel
authors.initials: S
authors.lastname: Biraro
authors.forename: Anatoli
authors.initials: A
authors.lastname: Kamali
authors.forename: Richard
authors.initials: R
authors.lastname: White
authors.forename: Alex
authors.initials: A
authors.lastname: Karabarinde
authors.forename: Juliet
authors.initials: J
authors.lastname: Nsiimire Ssendagala
authors.forename: Heiner
authors.initials: H
authors.lastname: Grosskurth
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D015497:HIV-1 / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
keywords: HIV; HSV-2; incidence; prevalence; trends
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