High prevalence of herpes simplex virus (HSV)- type 2 co-infection among HIV-positive women in Ukraine, but no increased HIV mother-to-child transmission risk.
BACKGROUND
Over 3500 HIV-positive women give birth annually in Ukraine, a setting with high prevalence of sexually transmitted infections. Herpes simplex virus Type 2 (HSV-2) co-infection may increase HIV mother-to-child transmission (MTCT) risk. We explored factors associated with HSV-2 seropositivity among HIV-positive women in Ukraine, and its impact on HIV MTCT.


METHODS
Data on 1513 HIV-positive women enrolled in the Ukraine European Collaborative Study from 2007 to 2012 were analysed. Poisson and logistic regression models respectively were fit to investigate factors associated with HSV-2 seropositivity and HIV MTCT.


RESULTS
Median maternal age was 27 years (IQR 24-31), 53% (796/1513) had been diagnosed with HIV during their most recent pregnancy and 20% had a history of injecting drugs. Median antenatal CD4 count was 430 cells/mm(3) (IQR 290-580). Ninety-six percent had received antiretroviral therapy antenatally. HSV-2 seroprevalence was 68% (1026/1513). In adjusted analyses, factors associated with HSV-2 antibodies were history of pregnancy termination (APR 1.30 (95% CI 1.18-1.43) for ≥ 2 vs. 0), having an HIV-positive partner (APR 1.15 (95% CI 1.05-1.26) vs partner's HIV status unknown) and HCV seropositivity (APR 1.23 (95 % CI 1.13-1.35)). The overall HIV MTCT rate was 2.80% (95% CI 1.98-3.84); no increased HIV MTCT risk was detected among HSV-2 seropositive women after adjusting for known risk factors (AOR 1.43 (95% CI 0.54-3.77).


CONCLUSIONS
No increased risk of HIV MTCT was detected among the 68% of HIV-positive women with antibodies to HSV-2, in this population with an overall HIV MTCT rate of 2.8%. Markers of ongoing sexual risk among HIV-positive HSV-2 seronegative women indicate the importance of interventions to prevent primary HSV-2 infection during pregnancy in this high-risk group.
Division of Infectious Diseases, University Hospital Bern, CH-3010, Bern, Switzerland. mail@aebi-popp.com.
Karoline
K
Aebi-Popp
Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK.
Heather
H
Bailey
Perinatal Prevention of AIDS Initiative, Odessa, Ukraine.
Ruslan
R
Malyuta
Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine.
Alla
A
Volokha
Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK.
Claire
C
Thorne
D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D060085:Coinfection; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D006558:Herpes Genitalis / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D018258:Herpesvirus 2, Human; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D016015:Logistic Models; D016012:Poisson Distribution; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D014455:Ukraine / Q000453:epidemiology; D055815:Young Adult
D000914:Antibodies, Viral
HIV; Herpes simplex virus; Mother to child transmission; Pregnancy