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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e31821acb5a
Original Article: PDF Only

Impact of Herpes Simplex Virus Type 2 on HIV-1 acquisition and progression in an HIV vaccine trial (the Step Study).

Barnabas, Ruanne V MBChB, DPhil; Wasserheit, Judith N MD, MPH; Huang, Yunda PhD; Janes, Holly PhD; Morrow, Rhoda PhD; Fuchs, Jonathan MD, MPH; Mark, Karen E MD, MPH; Casapia, Martin MD, MPH; Mehrotra, Devan V PhD; Buchbinder, Susan P MD; Corey, Lawrence MD; the NIAID HIV Vaccine Trials Network

Published Ahead-of-Print
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Abstract

Introduction: Extensive observational data suggest that HSV-2 infection may facilitate HIV acquisition, increase HIV viral load, and accelerate HIV progression and onward transmission. To explore these relationships, we examined the impact of pre-existing HSV-2 infection in an international HIV vaccine trial.

Methods: We analyzed the associations between prevalent HSV-2 infection and HIV-1 acquisition and progression among 1836 men who have sex with men (MSM). We used Cox proportional hazards regression models to estimate the association between HSV-2 infection and both HIV acquisition and ART initiation, and linear regression to explore the effect of HSV-2 on pre-ART viral load.

Results: HSV-2 infection increased risk of HIV-1 acquisition among all volunteers (adjusted hazard ratio 2.2; 95% CI, 1.4 to 3.5). Adjusting for demographic variables, circumcision, Ad5 titer and significant risk behaviors, the risk of HIV acquisition among HSV-2 infected placebo recipients was three fold higher than HSV-2 seronegatives (hazard ratio 3.3; 95% CI, 1.6 to 6.9). Past HSV-2 infection was associated with a 0.2 log10 copies/ml higher adjusted mean set point viral load (95% CI, 0.3 lower to 0.6 higher). HSV-2 infection was not associated with time to ART initiation.

Conclusions: Among MSM in an HIV-1 vaccine trial, pre-existing HSV-2 infection was a major risk factor for HIV acquisition. Past HSV-2 did not significantly increase HIV viral load or early disease progression. HSV-2 seropositive persons will likely prove more difficult than HSV-2 seronegative persons to protect against HIV infection using vaccines or other prevention strategies.

(C) 2014 by Lippincott Williams & Wilkins

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