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. 2018 Jul 2;218(3):443-452.
doi: 10.1093/infdis/jiy178.

Sexually Transmitted Bedfellows: Exquisite Association Between HIV and Herpes Simplex Virus Type 2 in 21 Communities in Southern Africa in the HIV Prevention Trials Network 071 (PopART) Study

John Bradley  1 , Sian Floyd  1 , Estelle Piwowar-Manning  2 , Oliver Laeyendecker  3 , Alicia Young  4 , Nomtha Bell-Mandla  5 , Justin Bwalya  6 , Peter Bock  5 , Sarah Fidler  7 , Helen Ayles  8   6 , Richard J Hayes  1 ; HPTN 071 (PopART) Study Team
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Sexually Transmitted Bedfellows: Exquisite Association Between HIV and Herpes Simplex Virus Type 2 in 21 Communities in Southern Africa in the HIV Prevention Trials Network 071 (PopART) Study

John Bradley et al. J Infect Dis. .

Abstract

Background: Human immunodeficiency virus (HIV) and herpes simplex virus type 2 (HSV2) are strongly associated, although mechanisms are not fully understood. An HIV prevention trial allowed reexamination of this association at individual and community levels.

Methods: The HIV Prevention Trials Network 071 (PopART) study evaluates a combination prevention intervention in 21 urban communities in Zambia and South Africa. To measure impact on HIV infection incidence, a cohort of approximately 2000 adults (age range, 18-44 years) was selected randomly from each community. Baseline data on sociodemographic characteristics, behavior, and HIV/HSV2 serologic findings were used to examine the association between HIV and HSV2. At the community level, HIV prevalence was plotted against HSV2 prevalence.

Results: A total of 38691 adults participated. HSV2 prevalence among women and men was 50% and 22%, respectively, in Zambia and 60% and 27%, respectively, in South Africa. Estimated HSV2 infection incidence among those aged 18-24 years was 8.06 cases/100 person-years (95% confidence interval [CI], 6.76-9.35) and 1.76 cases/100 person-years (95% CI, 1.30-2.22) among women and men, respectively. A 6-fold higher odds of HIV infection was seen in HSV2-infected individuals in both sexes, after adjustment for confounders (odds ratio, 6.66 [95% CI, 6.07-7.31] among women and 6.57 [95% CI, 5.56-7.77] among men). At the community-level, there was a strong linear relationship between HIV and HSV2 prevalence (ρ = 0.92; P < .001).

Conclusions: There was an exquisite association between these 2 infections, at the individual and community levels, likely due in part to a powerful cofactor effect of HSV2 on HIV transmission. HSV2 control could contribute to HIV prevention.

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Figures

Figure 1.
Figure 1.
Herpes simplex virus type 2 (HSV2) prevalence, by sex, country, and age group, in all age groups (left) and those aged <25 years (right).
Figure 2.
Figure 2.
Community-level association between herpes simplex virus type 2 (HSV2) prevalence and human immunodeficiency virus (HIV) prevalence.
Figure 3.
Figure 3.
Community-level association between lifetime number of sex partners and herpes simplex virus type 2 (HSV2) prevalence.
See this image and copyright information in PMC

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