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Maternal herpes simplex virus type 2 coinfection increases the risk of perinatal HIV transmission: possibility to further decrease transmission?

Bollen, Liesbeth JMa; Whitehead, Sara Ja,b; Mock, Philip Aa; Leelawiwat, Wannaa; Asavapiriyanont, Suvannac; Chalermchockchareonkit, Amphand; Vanprapar, Nirund; Chotpitayasunondh, Taweec; McNicholl, Janet Ma,b; Tappero, Jordan Wa,b; Shaffer, Nathanb; Chuachoowong, Rutta,d

doi: 10.1097/QAD.0b013e3282fec42a
Epidemiology and Social

Objectives: To evaluate the association between maternal herpes simplex virus type 2 seropositivity and genital herpes simplex virus type 2 shedding with perinatal HIV transmission.

Study design: Evaluation of women who participated in a 1996–1997 perinatal HIV transmission prevention trial in Thailand.

Methods: In this nonbreastfeeding population, women were randomized to zidovudine or placebo from 36 weeks gestation through delivery; maternal plasma and cervicovaginal HIV viral load and infant HIV status were determined for the original study. Stored maternal plasma and cervicovaginal samples were tested for herpes simplex virus type 2 antibodies by enzyme-linked immunoassay and for herpes simplex virus type 2 DNA by real-time PCR, respectively.

Results: Among 307 HIV-positive women with available samples, 228 (74.3%) were herpes simplex virus type 2 seropositive and 24 (7.8%) were shedding herpes simplex virus type 2. Herpes simplex virus type 2 seropositivity was associated with overall perinatal HIV transmission [adjusted odds ratio, 2.6; 95% confidence interval, 1.0–6.7)], and herpes simplex virus type 2 shedding was associated with intrapartum transmission (adjusted odds ratio, 2.9; 95% confidence interval, 1.0–8.5) independent of plasma and cervicovaginal HIV viral load, and zidovudine treatment. Median plasma HIV viral load was higher among herpes simplex virus type 2 shedders (4.2 vs. 4.1 log10copies/ml; P = 0.05), and more shedders had quantifiable levels of HIV in cervicovaginal samples, compared with women not shedding herpes simplex virus type 2 (62.5 vs. 34.3%; P = 0.005).

Conclusion: We found an increased risk of perinatal HIV transmission among herpes simplex virus type 2 seropositive women and an increased risk of intrapartum HIV transmission among women shedding herpes simplex virus type 2. These novel findings suggest that interventions to control herpes simplex virus type 2 infection could further reduce perinatal HIV transmission.

From the aThailand Ministry of Public Health, US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand

bCenters for Disease Control and Prevention, Atlanta, Georgia, USA

cRajavithi Hospital and Queen Sirikit National Institute for Child Health, Department of Medical Services, Ministry of Public Health, Bangkok

dFaculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Thailand.

Received 22 November, 2007

Revised 12 February, 2008

Accepted 20 February, 2008

Correspondence to Liesbeth J.M. Bollen, MD, PhD, Thailand MOPH – U.S. CDC Collaboration, Ministry of Public Health, Soi 4, P.O. Box 139, Nonthaburi 11000, Thailand. E-mail: Lbollen@tuc.or.th or Lbollen@fhi.or.id

© 2008 Lippincott Williams & Wilkins, Inc.