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Incident HIV and herpes simplex virus type 2 infection among men in Rakai, Uganda

Tobian, Aaron ARa; Ssempijja, Victorb; Kigozi, Godfreyc; Oliver, Amy Ed; Serwadda, Davidc; Makumbi, Frederickc; Nalugoda, Frederick Kb; Iga, Boazb; Reynolds, Steven Jd,e; Wawer, Maria Jf; Quinn, Thomas Cd,e; Gray, Ronald Hf

doi: 10.1097/QAD.0b013e32832d4042
Epidemiology and social: CONCISE COMMUNICATION

Objective: Herpes simplex virus type 2 (HSV-2) infection is associated with an increased risk for acquiring HIV, but little is known about the temporal sequence of these infections.

Design: Six thousand three hundred ninety-six men were evaluated for serologic HSV-2 and HIV infections and behaviors during a male circumcision trial in Rakai, Uganda.

Methods: HIV and HSV-2 status were determined using enzyme-linked immunosorbent assays and confirmed by HIV-1 and HSV-2 western blots. A Poisson multivariable model was used to estimate adjusted incidence rate ratios of HIV acquisition associated with HSV-2 and other covariates.

Results: HIV incidence was 1.09/100 person-years and acquisition was associated with incident HSV-2 infection [adjusted incidence rate ratio (adjIRR) 5.28, 95% confidence interval (CI) 2.79–9.98], chronic HSV-2 infection (adjIRR 2.78, 95% CI 1.64–5.68), genital ulcer disease, urethral discharge, genital washing after intercourse, being unmarried, and being uncircumcised. Sixteen men acquired both HIV and HSV-2 during the trial: four acquired HIV first, three acquired HSV-2 first, and nine acquired both infections in the same follow-up interval.

Conclusion: The findings suggest that unsafe sex places men at risk of both HIV and HSV-2 infections, and it is unclear whether HSV-2 acquisition is a cofactor for HIV infection or a marker of correlated sexual exposures. This reinforces the need for promotion of safe sex as the primary method of prevention of both viruses.

aDepartment of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA

bRakai Health Sciences Program, Entebbe, Uganda

cSchool of Public Health, Makerere University, Kampala, Uganda

dDepartment of Medicine, School of Medicine, Johns Hopkins University, Baltimore

eDivision of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA

fDepartment of Population, Family and Reproductive Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.

Received 20 March, 2009

Revised 15 April, 2009

Accepted 22 April, 2009

Correspondence to Thomas C. Quinn, Rangos Building, Room 530, 855 N. Wolfe St, Baltimore, MD 21205, USA. Tel: +1 410 955 3151; fax: +1 410 614 9775; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.