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Herpes simplex virus type 2, genital ulcers and HIV-1 disease progression in postpartum women.

Roxby AC, Drake AL, John-Stewart G, Brown ER, Matemo D, Otieno PA, Farquhar C - PLoS ONE (2011)

Bottom Line: The impact of HSV-2 on clinical outcomes among HIV-1 infected pregnant women is unclear.Among 296 women, 254 (86%) were HSV-2-seropositive.Adjusting for baseline CD4, women with GUD were significantly more likely to have incident OIs (adjusted hazard ratio (aHR) 2.79, 95% CI: 1.33-5.85), and there was a trend for association between HSV-2-seropositivity and incident OIs (aHR 3.83, 95% CI: 0.93-15.83).

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of Washington, Seattle, Washington, United States of America. aroxby@u.washington.edu

ABSTRACT

Background: Co-infection with herpes simplex virus type 2 (HSV-2) has been associated with increased HIV-1 RNA levels and immune activation, two predictors of HIV-1 progression. The impact of HSV-2 on clinical outcomes among HIV-1 infected pregnant women is unclear.

Methods: HIV-1 infected pregnant women in Nairobi were enrolled antenatally and HSV-2 serology was obtained. HIV-1 RNA and CD4 count were serially measured for 12-24 months postpartum. Survival analysis using endpoints of death, opportunistic infection (OI), and CD4<200 cells µL, and linear mixed models estimating rate of change of HIV-1 RNA and CD4, were used to determine associations between HSV-2 serostatus and HIV-1 progression.

Results: Among 296 women, 254 (86%) were HSV-2-seropositive. Only 30 (10%) women had prior or current genital ulcer disease (GUD); median baseline CD4 count was 422 cells µL. Adjusting for baseline CD4, women with GUD were significantly more likely to have incident OIs (adjusted hazard ratio (aHR) 2.79, 95% CI: 1.33-5.85), and there was a trend for association between HSV-2-seropositivity and incident OIs (aHR 3.83, 95% CI: 0.93-15.83). Rate of change in CD4 count and HIV-1 RNA did not differ by HSV-2 status or GUD, despite a trend toward higher baseline HIV-1 RNA in HSV-2-seropositive women (4.73 log10 copies/ml vs. 4.47 log10 copies/ml, P = 0.07).

Conclusions: HSV-2 was highly prevalent and pregnant HIV-1 infected women with GUD were significantly more likely to have incident OIs than women without GUD, suggesting that clinically evident HSV-2 is a more important predictor of HIV-1 disease progression than asymptomatic HSV-2.

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Scatterplot of Log10 HIV-1 RNA Level Over Time, by HSV-2 Serostatus at Baseline.Points represent individual measures of log10 HIV-1 RNA levels. Curves represent locally weighted smoothed curves of log10 HIV-1 RNA levels over time, by HSV-2 serostatus. Time = months since delivery.
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pone-0019947-g002: Scatterplot of Log10 HIV-1 RNA Level Over Time, by HSV-2 Serostatus at Baseline.Points represent individual measures of log10 HIV-1 RNA levels. Curves represent locally weighted smoothed curves of log10 HIV-1 RNA levels over time, by HSV-2 serostatus. Time = months since delivery.

Mentions: There was a trend toward an association between HSV-2-seropositivity and incident OI; 17% of the HSV-2-seropositive women had an incident OI during follow-up, compared to 5% of the HSV-2-seronegative women (HR 3.66, 95% CI: 0.88–15.11, P = 0.07) (Figure 1). In a model adjusted for baseline CD4, the relationship between HSV-2-seropositivity and OI persisted (Adjusted HR (aHR) 3.83, 95% CI: 0.93–15.83, P = 0.06) (Table 2). Progression to CD4≤200 cells/µl was similar between HSV-2-seropositive and seronegative women (HR 1.15, 95% CI: 0.52–2.53, P = 0.74), and changes in plasma HIV-1 RNA did not differ significantly by HSV-2 serostatus (Figure 2). HSV-2 serostatus did not show a significant effect on rates of change in CD4; the average rate of change of CD4 cells/µl/month was −3.42 cells/µl/month in the HSV-2-seronegative group and −4.22 cells/µl/month in the HSV-2-seropositive group (P = 0.57).


Herpes simplex virus type 2, genital ulcers and HIV-1 disease progression in postpartum women.

Roxby AC, Drake AL, John-Stewart G, Brown ER, Matemo D, Otieno PA, Farquhar C - PLoS ONE (2011)

Scatterplot of Log10 HIV-1 RNA Level Over Time, by HSV-2 Serostatus at Baseline.Points represent individual measures of log10 HIV-1 RNA levels. Curves represent locally weighted smoothed curves of log10 HIV-1 RNA levels over time, by HSV-2 serostatus. Time = months since delivery.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3102671&req=5

pone-0019947-g002: Scatterplot of Log10 HIV-1 RNA Level Over Time, by HSV-2 Serostatus at Baseline.Points represent individual measures of log10 HIV-1 RNA levels. Curves represent locally weighted smoothed curves of log10 HIV-1 RNA levels over time, by HSV-2 serostatus. Time = months since delivery.
Mentions: There was a trend toward an association between HSV-2-seropositivity and incident OI; 17% of the HSV-2-seropositive women had an incident OI during follow-up, compared to 5% of the HSV-2-seronegative women (HR 3.66, 95% CI: 0.88–15.11, P = 0.07) (Figure 1). In a model adjusted for baseline CD4, the relationship between HSV-2-seropositivity and OI persisted (Adjusted HR (aHR) 3.83, 95% CI: 0.93–15.83, P = 0.06) (Table 2). Progression to CD4≤200 cells/µl was similar between HSV-2-seropositive and seronegative women (HR 1.15, 95% CI: 0.52–2.53, P = 0.74), and changes in plasma HIV-1 RNA did not differ significantly by HSV-2 serostatus (Figure 2). HSV-2 serostatus did not show a significant effect on rates of change in CD4; the average rate of change of CD4 cells/µl/month was −3.42 cells/µl/month in the HSV-2-seronegative group and −4.22 cells/µl/month in the HSV-2-seropositive group (P = 0.57).

Bottom Line: The impact of HSV-2 on clinical outcomes among HIV-1 infected pregnant women is unclear.Among 296 women, 254 (86%) were HSV-2-seropositive.Adjusting for baseline CD4, women with GUD were significantly more likely to have incident OIs (adjusted hazard ratio (aHR) 2.79, 95% CI: 1.33-5.85), and there was a trend for association between HSV-2-seropositivity and incident OIs (aHR 3.83, 95% CI: 0.93-15.83).

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of Washington, Seattle, Washington, United States of America. aroxby@u.washington.edu

ABSTRACT

Background: Co-infection with herpes simplex virus type 2 (HSV-2) has been associated with increased HIV-1 RNA levels and immune activation, two predictors of HIV-1 progression. The impact of HSV-2 on clinical outcomes among HIV-1 infected pregnant women is unclear.

Methods: HIV-1 infected pregnant women in Nairobi were enrolled antenatally and HSV-2 serology was obtained. HIV-1 RNA and CD4 count were serially measured for 12-24 months postpartum. Survival analysis using endpoints of death, opportunistic infection (OI), and CD4<200 cells µL, and linear mixed models estimating rate of change of HIV-1 RNA and CD4, were used to determine associations between HSV-2 serostatus and HIV-1 progression.

Results: Among 296 women, 254 (86%) were HSV-2-seropositive. Only 30 (10%) women had prior or current genital ulcer disease (GUD); median baseline CD4 count was 422 cells µL. Adjusting for baseline CD4, women with GUD were significantly more likely to have incident OIs (adjusted hazard ratio (aHR) 2.79, 95% CI: 1.33-5.85), and there was a trend for association between HSV-2-seropositivity and incident OIs (aHR 3.83, 95% CI: 0.93-15.83). Rate of change in CD4 count and HIV-1 RNA did not differ by HSV-2 status or GUD, despite a trend toward higher baseline HIV-1 RNA in HSV-2-seropositive women (4.73 log10 copies/ml vs. 4.47 log10 copies/ml, P = 0.07).

Conclusions: HSV-2 was highly prevalent and pregnant HIV-1 infected women with GUD were significantly more likely to have incident OIs than women without GUD, suggesting that clinically evident HSV-2 is a more important predictor of HIV-1 disease progression than asymptomatic HSV-2.

Show MeSH
Related in: MedlinePlus