Brief Report: Herpes Simplex Virus Type-2 Shedding and Genital Ulcers During Early HIV in Zimbabwean Women. (1st June 2021)

• Record Type: Journal Article
• Authors: Nowak, Rebecca G.; Liska, Tobias A.; Bentzen, Søren M.; Kim, Esther; Chipato, Tsungai; Salata, Robert A.; Celentano, David D.; Morrison, Charles S.; Gravitt, Patti E.
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 87:Number 2(2021)
• Page Start: 789
• Page End: 793
• Publication Date: 2021-06-01
• Subjects: HIV seroconversion -- HSV-2 -- viral shedding -- genital ulcers; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000002641
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Supplemental Digital Content is Available in the Text. Abstract : Background: Herpes simplex virus type-2 (HSV-2) seropositive persons have a 3- to 5-fold higher risk of acquiring HIV, possibly because of HSV-2–induced inflammation and recruitment of susceptible immune cells to exposure sites. We hypothesized that cervical HSV-2 activation (ie, viral DNA shedding and/or ulcers) preceded HIV acquisition in the hormonal contraception and HIV cohort. Methods: Zimbabwean women who acquired HIV were matched to HIV-negative women on visit, age, and bacterial sexually transmitted infections. Up to 5 cervical swabs bracketing first polymerase chain reaction detection of HIV DNA (the index visit) were selected ( t -6months, t -3months, t index, t +3months, t +6months ). Women with HSV-2 immunoglobulin G+ before t index were polymerase chain reaction tested for viral shedding. Self-reported and clinician-diagnosed ulcers were documented. Multivariable logistic regression, accounting for matching, estimated adjusted odds ratios (aOR) and 95% confidence intervals (CIs) at each visit. Results: Of 387 HSV-2 seropositive women, most had prevalent as compared with incident HSV-2 (91% vs. 9%, respectively). HSV-2 viral shedding was more common among HIV seroconverters than HIV-negative women (26% vs. 14%, P < 0.01). Shedding occurred around HIV acquisition ( t -3months aOR, 2.7; 95% CI, 0.8 to 8.8; t index aOR, 2.6; 95% CI, 1.1 to 6.5; t +3months aOR, 2.6; 95% CI, 1.0 to 6.6). Genital ulcers were reported more often among HIV seroconverters than HIV-negative women (13% vs. 7%; P = 0.06) and detection was after HIV acquisition ( t +6months aOR, 14.5; 95% CI, 1.6 to 133.9). Conclusions: HSV-2 shedding appeared synergistic with HIV acquisition followed by presentation of ulcers. Evaluating all sexually transmitted infections rather than HSV-2 alone may clarify the relationship between inflammation and HIV acquisition.