From the Journals

Herpes simplex type 2 infection markedly increases HIV risk

 

Key clinical point: People with herpes simplex type 2 (HSV-2) are at an increased risk of HIV infection, particularly those with new infections.

Major finding: The adjusted relative risk of HIV incidence after exposure to prevalent HSV-2 was 2.7 (95% CI, 2.2-3.4) and was 4.7 after exposure to incident HSV-2 (95% CI, 2.2-10.1).

Data source: A systematic review and meta-analysis of 57 longitudinal studies on the risk of HIV acquisition associated with HSV-2 infection.

Disclosures: The study was funded by the World Health Organization. One lead author reported personal fees from the World Health Organization; the other reported grants from the National Institutes of Health and the Wellcome Trust outside of this study. Two authors reported financial support from Aquarius Population Health and other support from WHO and NIH; the three remaining authors had no disclosures.

View on the News

More creative approaches needed for HIV prevention

The incidence of HIV infection has not changed in a decade. Development of successful strategies to prevent HIV acquisition might require more creative approaches to meet the needs of the most susceptible populations, including exploration of the role of sexually transmitted infections, such as herpes simplex virus type 2 (HSV-2), in HIV infection.

This study provides the first systematic review and meta-analysis in more than a decade to assess the effect of HSV-2 infection on subsequent HIV acquisition. There are some preventative treatments available for HIV and HSV-2, but they have poor availability in low-income regions that have the highest risk of infection. Therefore, other multipurpose prevention technologies for HSV-2 and HIV are needed to give individuals a broad range of prevention options and to target the lifestyles and preferences of the most susceptible populations, including young women in Africa who have the highest incidence of HIV and HSV-2 worldwide.

Thomas M. Zydowsky, PhD , is the director of biomedical research and pharmaceutical development in the HIV and AIDS program at the Population Council’s Center for Biomedical Research in New York. His commentary accompanied the Looker et al. study ( Lancet Infect Dis. 2017 Aug 23. pii: S1473-3099[17]30493-0. doi: 10.1016/S1473-3099[17]30493-0 ). He reported no financial conflicts of interest.


 

FROM THE LANCET: INFECTIOUS DISEASES

The risk of contracting HIV was almost three to five times higher among people infected with herpes simplex virus type 2 (HSV-2), in a systematic review and meta-analysis.

The analysis of 57 longitudinal studies found that the adjusted relative risk (RR) of HIV incidence after exposure to HSV-2 infection at baseline (“prevalent infection”) was 2.7 and was 4.7 after exposure to HSV-2 infection during follow-up (“incident infection”). The studies, mostly conducted in Africa, were found in PubMed, MEDLINE, and Embase publications from Jan. 1, 2003, to May 25, 2017; the analysis was published online on Aug. 23 (Lancet Infect Dis. 2017. pii: S1473-3099[17]30405-X. doi: 10.1016/S1473-3099[17]30405-X).

“The greater cofactor effect for incident HSV-2 infection than for prevalent HSV-2 infection might be because newly acquired HSV-2 infection is associated with an increased frequency and severity of genital ulceration, viral shedding, and inflammation in the genital tract, symptoms and manifestations that decrease with time after infection,” according to Katharine J. Looker, PhD, of the University of Bristol (England), and Jocelyn A.R. Elmes, PhD, of Imperial College London (England) and their coauthors.

Associations still were significant but lower in higher-risk populations, such as female sex workers and their clients, men who have sex with men, and serodiscordant couples, the researchers said. For those with prevalent HSV-2, the adjusted RR of contracting HIV was 1.7 (95% confidence interval, 1.4-2.1), compared with 2.9 for those with incident HSV-2 infection (95% CI, 1.7-5.0).

“Quantifying the effect of HSV-2 infection on HIV acquisition has important public health implications, particularly in high-prevalence settings where coinfection is common, because prevention of HSV-2 infection ... might indirectly prevent HIV infection,” the authors wrote. “Knowledge of this association informs the advice and information given to individuals diagnosed with genital herpes, who might be at increased risk of acquiring HIV.”

The study was funded by the World Health Organization. Dr. Looker reported personal fees from the WHO. Dr. Elmes reported grants from the National Institutes of Health and the Wellcome Trust outside of this study. Two authors reported financial support from Aquarius Population Health and other support from WHO and NIH; the three remaining authors had no disclosures.

   Comments ()