[MoOrC1012] Recent Herpes Simplex Virus Type 2 Infection and the Risk of HIV Acquisition in Pune, India

14th International AIDS Conference

Barcelona, Spain — July 7-12, 2002

[TITLE:] Recent Herpes Simplex Virus Type 2 Infection and the Risk of HIV Acquisition in Pune, India

[AUTHOR(S):] S.J. Reynolds, M.E. Shepherd, J.M. Zenilman, R.S. Brookmeyer, R.C. Bollinger¹, A.R. Risbud, S.V. Kulkarni, S.M. Mehendale²

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. MoOrC1012

BACKGROUND: Few studies have evaluated the impact of acute herpes simplex virus type 2 (HSV-2) infection on HIV acquisition, although a number of studies have identified genital ulcer disease as a major risk factor for HIV infection. We hypothesized that primary genital HSV-2 infection is a critical risk factor for primary HIV infection.

METHODS: A retrospective cohort study of 2732 HIV-1-seronegative patients attending 3 sexually transmitted disease and 1 gynecology clinic, continuously enrolled from 1993-2000 in an ongoing prospective study of acute HIV infection was undertaken in Pune, India. Stored sera were used to establish HSV-2 seroprevalence and seroincidence using the HerpeSelect EIA (Focus Technologies, Cypress, CA). Incident HSV-2 infection was categorized as recent or remote (within the past 6 months or more than 6 months, respectively).

RESULTS: 1175(43%) of the participants were infected with HSV-2 at the baseline visit. Among those initially HSV-2 seronegative, the HSV-2 incidence was 11.4/100py(95% CI 9.9-13.0). Based on a median follow-up time of 11 months, the incidence of HIV-1 was 5.8/100py(95%CI 5.0-6.6). Using a Cox proportional hazards model to adjust for known HIV risk factors, the adjusted relative risk of HIV acquisition associated with chronic (prevalent) HSV-2 infection was 1.69(95%CI 1.23-2.33; p=0.001) and 1.81(95%CI 1.09-3.03; p=.02) with remote primary HSV-2 infection. Recent HSV-2 infection was independently associated with a 3.64-fold increased risk of primary HIV infection(95%CI 1.72-7.70; p<.001).

CONCLUSIONS: Recent HSV-2 infection is a major independent risk factor for acquisition of HIV infection among Indian STD patients. Our findings support the hypothesis that mucosal ulceration from acute HSV-2 infection may be a key biological mechanism which facilitates HIV acquisition. These data also suggest that prevention of primary HSV-2 infection may significantly reduce the risk of HIV infection in this setting.

Presenting author: Steven Reynolds

Download Presentation

1Johns Hopkins University, Johns Hopkins University, Division of Infectious Diseases, Ross Building, Room 1150, Baltimore, MD, 21205, United States.

2National AIDS Research Institute, Pune, India.

020708
MoOrC1012