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. 2007 Feb;109(2 Pt 1):403-9.
doi: 10.1097/01.AOG.0000251511.27725.5c.

Herpes simplex virus type 2 and risk of intrapartum human immunodeficiency virus transmission

Alison L Drake  1 , Grace C John-Stewart, Anna Wald, Dorothy A Mbori-Ngacha, Rose Bosire, Dalton C Wamalwa, Barbara L Lohman-Payne, Rhoda Ashley-Morrow, Lawrence Corey, Carey Farquhar
Affiliations

Herpes simplex virus type 2 and risk of intrapartum human immunodeficiency virus transmission

Alison L Drake et al. Obstet Gynecol. 2007 Feb.

Erratum in

  • Obstet Gynecol. 2007 Apr;109(4):1002-3

Abstract

Objective: To determine whether herpes simplex virus type 2 (HSV-2) infection was associated with risk of intrapartum human immunodeficiency virus type 1 (HIV-1) transmission and to define correlates of HSV-2 infection among HIV-1-seropositive pregnant women.

Methods: We performed a nested case control study within a perinatal cohort in Nairobi, Kenya. Herpes simplex virus type 2 serostatus and the presence of genital ulcers were ascertained at 32 weeks of gestation. Maternal cervical and plasma HIV-1 RNA and cervical HSV DNA were measured at delivery.

Results: One hundred fifty-two (87%) of 175 HIV-1-infected mothers were HSV-2-seropositive. Among the 152 HSV-2-seropositive women, nine (6%) had genital ulcers at 32 weeks of gestation, and 13 (9%) were shedding HSV in cervical secretions. Genital ulcers were associated with increased plasma HIV-1 RNA levels (P=.02) and an increased risk of intrapartum HIV-1 transmission (16% of transmitters versus 3% of nontransmitters had ulcers; P = .003), an association which was maintained in multivariable analysis adjusting for plasma HIV-1 RNA levels (P=.04). We found a borderline association for higher plasma HIV-1 RNA among women shedding HSV (P=.07) and no association between cervical HSV shedding and either cervical HIV-1 RNA levels or intrapartum HIV-1 transmission (P=.4 and P=.5, [corrected] respectively).

Conclusion: Herpes simplex virus type 2 is the leading cause of genital ulcers among women in sub-Saharan Africa and was highly prevalent in this cohort of pregnant women receiving prophylactic zidovudine. After adjusting for plasma HIV-1 RNA levels, genital ulcers were associated with increased risk of intrapartum HIV-1 transmission. These data suggest that management of HSV-2 during pregnancy may enhance mother-to-child HIV-1 prevention efforts.

Level of evidence: II.

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