HSV-2 co-infection as a driver of HIV transmission among heterosexual non-injecting drug users in New York City.
OBJECTIVE
To examine herpes simplex virus 2 (HSV-2)/HIV co-infection as a contributing factor in the increase in HIV infection among non-injecting heroin and cocaine users in New York City.


METHODS
Subjects were recruited from the Beth Israel Medical Center drug detoxification and methadone maintenance programs in New York City in 1995-1999 and 2005-2011. All reported current heroin and/or cocaine use and no injection drug use. A structured questionnaire was administered and serum samples collected for HIV and HSV-2 testing. Population-attributable risk percentages (PAR%s) were estimated for associations between HSV-2 and increased susceptibility to and increased transmissibility of HIV among female NIDUs.


RESULTS
785 subjects were recruited from 1995-1999, and 1764 subjects from 2005-2011. HIV prevalence increased from 7% to 13%, with nearly uniform increases among all demographic subgroups. HSV-2/HIV co-infection was common in both time periods, with an average (over the two time periods) of 80% of HIV negative females infected with HSV-2, an average of 43% of HIV negative males infected with HSV-2; an average of 97% of HIV positive females also infected with HSV-2 and an average of 67% of HIV positive males also infected with HSV-2. The increase in HIV prevalence was predominantly an increase in HSV-2/HIV co-infection, with relatively little HIV mono-infection in either time period. The estimated PAR%s indicate that approximately half of HIV acquisition among females was caused by HSV-2 infection and approximately 60% of HIV transmission from females was due to HSV-2 co-infection.


CONCLUSIONS
The increase in HIV infection among these non-injecting drug users is better considered as an increase in HSV-2/HIV co-infection rather than simply an increase in HIV prevalence. Additional interventions (such as treatment as prevention and suppressing the effects of HSV-2 on HIV transmission) are needed to reduce further HIV transmission from HSV-2/HIV co-infected non-injecting drug users.
The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, United States of America.
Don C
DC
Des Jarlais
The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, United States of America.
Kamyar
K
Arasteh
The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, United States of America.
Courtney
C
McKnight
The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, United States of America.
David C
DC
Perlman
The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, United States of America.
Jonathan
J
Feelemyer
School of Nursing, New York University, New York, New York, United States of America.
Holly
H
Hagan
Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
Hannah L F
HL
Cooper
D000328:Adult; D019970:Cocaine-Related Disorders / Q000150:complications / Q000453:epidemiology*; D055030:Drug Users; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission; D006556:Heroin Dependence / Q000150:complications / Q000453:epidemiology*; D006558:Herpes Genitalis / Q000453:epidemiology / Q000635:transmission; D018258:Herpesvirus 2, Human; D020010:Heterosexuality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012737:Sex Factors