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Incidence, Prevalence, and Epidemiology of Herpes Simplex Virus-2 in HIV-1-Positive and HIV-1-Negative Adolescents

Sudenga, Staci L. MPH*; Kempf, Mirjam-Colette PhD, MPH†,‡; McGwin, Gerald Jr. PhD, MS*; Wilson, Craig M. MD*; Hook, Edward W. III MD§; Shrestha, Sadeep PhD, MHS, MS*

Sexually Transmitted Diseases: April 2012 - Volume 39 - Issue 4 - p 300–305
doi: 10.1097/OLQ.0b013e318244a90f
Original Study

Background: Several studies have assessed risk factors associated with herpes simplex virus-2 (HSV-2) prevalence in adults; however, few have focused on HSV-2 incidence, particularly in adolescents. The objective of this study was to determine HSV-2 prevalence and incidence and associated risk factors in a HIV-1-positive and at risk HIV-1-negative adolescent population.

Methods: Sera were tested for HSV-2 antibodies in 518 adolescents in the Reaching for Excellence in Adolescent Care and Health cohort at baseline and again at the final follow-up visit. Prevalence at baseline and incidence (per person years) of HSV-2 infection were calculated. Furthermore, among HIV-1-positive individuals, a subgroup analysis was performed to assess risk factors for HSV-2 infection. Conditional logistic regression was used to estimate odds ratios and P values for associations between CD4+ T-cell (CD4+) count, HIV-1 viral load (VL), and HSV-2 acquisition, adjusting for antiretroviral therapy use, other sexually transmitted infections, gender, race, and number of sexual partners.

Results: At baseline, 179 (35%) subjects were HSV-2 positive, with an additional 47 (16%) new cases being identified during a median follow-up time of 1.95 years and an incidence rate of 7.35 cases per 100 person years. Several risk factors were associated with HSV-2 prevalence (being female, non-Hispanic, uncertainty of sexual preference, and HIV-1 positive) and incidence (using drugs, alcohol, and number of new sexual partners). Among HIV-1 positives, an increase in CD4+ count by 50 cell/mm3 (odds ratio, 1.17; 95% CI, 1.04–1.31, P = 0.008) was associated with HSV-2 acquisition.

Conclusions: The high prevalence and incidence of HSV-2 infection among adolescents, compared with the general population at this age group suggests a critical need for screening and preventive programs among this targeted group.

Adolescents in the Reaching for Excellence in Adolescent Care and Health study had high prevalence and incidence rates of herpes simplex virus-2 infection that were associated with being female, non-Hispanic, HIV-1 positive, unknown sexual preference, drug and alcohol use, and number of sexual partners.

From the Departments of *Epidemiology and Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Department of Family/Child Caregiving, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama; and §Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama

The authors thank REACH investigators, staff, and participants for their valuable contributions (listed in J Adolesc Health 2001; 29: S5–S6). The parent study and this substudy conformed to the procedures for informed consent (parental permission was obtained wherever required) approved by institutional review boards at all sponsoring organizations and to human-experimentation guidelines set forth by the U.S. Department of Health and Human Services. The REACH study (1994–2001) was supported by the National Institute of Child Health and Human Development (U01-HD32830), with supplemental funding from the National Institute of Allergy and Infectious Diseases, the National Institute on Drug Abuse, and the National Institute of Mental Health. The authors also thank their team within the Basic Research in Infectious Disease and Genetic Epidemiology (BRIDGE) group for valuable discussions.

Supported in part by a developmental award from the UAB Center for AIDS Research (5P30 AI27767-20) and the NIH Cancer Prevention and Control Training Grant (R25CA47888).

Correspondence: Sadeep Shrestha, PhD, MHS, MS, Department of Epidemiology, R217, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL 35294-0022. E-mail:

Received for publication July 1, 2011, and accepted December 1, 2011.

© Copyright 2012 American Sexually Transmitted Diseases Association