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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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Related in: MedlinePlus

Risk of Opportunistic Infection, by GUD (Kaplan-Meier Estimates).Opportunistic infection is defined as: first episode of herpes zoster, Pneumocystis jirovecii pneumonia, tuberculosis, Kaposi sarcoma, meningitis, or encephalitis. Relative risk calculated using Cox regression. Time = months since delivery.
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pone-0019947-g003: Risk of Opportunistic Infection, by GUD (Kaplan-Meier Estimates).Opportunistic infection is defined as: first episode of herpes zoster, Pneumocystis jirovecii pneumonia, tuberculosis, Kaposi sarcoma, meningitis, or encephalitis. Relative risk calculated using Cox regression. Time = months since delivery.

Mentions: GUD was found to be significantly associated with incident OIs (HR 2.42, 95% CI: 1.16–5.02, P = 0.02) (Figure 3), and this relationship strengthened after adjusting for baseline CD4 (aHR 2.79, 95% CI: 1.33–5.85, P = 0.007) (Table 2). Nearly one-third (30%) of the women with GUD had an OI during follow-up, compared with only 14% of the women who had not experienced GUD. The rate of change of HIV-1 RNA was similar for women with and without GUD. The rate of decline of CD4 count was −4.34 cells/µl/month for those without GUD vs. −2.34 cells/µl/month for those with GUD, but this difference was not statistically significant (P = 0.25).


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)

Risk of Opportunistic Infection, by GUD (Kaplan-Meier Estimates).Opportunistic infection is defined as: first episode of herpes zoster, Pneumocystis jirovecii pneumonia, tuberculosis, Kaposi sarcoma, meningitis, or encephalitis. Relative risk calculated using Cox regression. Time = months since delivery.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3102671&req=5

pone-0019947-g003: Risk of Opportunistic Infection, by GUD (Kaplan-Meier Estimates).Opportunistic infection is defined as: first episode of herpes zoster, Pneumocystis jirovecii pneumonia, tuberculosis, Kaposi sarcoma, meningitis, or encephalitis. Relative risk calculated using Cox regression. Time = months since delivery.
Mentions: GUD was found to be significantly associated with incident OIs (HR 2.42, 95% CI: 1.16–5.02, P = 0.02) (Figure 3), and this relationship strengthened after adjusting for baseline CD4 (aHR 2.79, 95% CI: 1.33–5.85, P = 0.007) (Table 2). Nearly one-third (30%) of the women with GUD had an OI during follow-up, compared with only 14% of the women who had not experienced GUD. The rate of change of HIV-1 RNA was similar for women with and without GUD. The rate of decline of CD4 count was −4.34 cells/µl/month for those without GUD vs. −2.34 cells/µl/month for those with GUD, but this difference was not statistically significant (P = 0.25).

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