Cervicovaginal HIV-1 and herpes simplex virus type 2 shedding during genital ulcer disease episodes

AIDS. 2007 Jul 31;21(12):1569-78. doi: 10.1097/QAD.0b013e32825a69bd.


Objective: To investigate correlates of herpes simplex virus type 2 (HSV-2) DNA and HIV-1 RNA among women with genital ulcer disease (GUD).

Design: Baseline data from a randomized placebo-controlled trial of episodic herpes treatment in Ghana and the Central African Republic.

Methods: GUD aetiology was determined by polymerase chain reaction (PCR) from a lesional swab. Real-time PCR was used to quantify HIV-1 RNA, and HSV-2 DNA in cervicovaginal lavages (CVL) and HIV-1 RNA in plasma. Genital infection was defined as the presence of virus in the lesion or CVL.

Results: Of 441 women enrolled, 79.0% were HSV-2 seropositive, 46.6% were HIV-1 seropositive, and 50.0% had an HSV-2 ulcer. Among 180 HSV-2/HIV-1 co-infected women, cervicovaginal HIV-1 RNA was detected more frequently in women with HSV-2 ulcers (67.9%) or cervicovaginal HSV-2 DNA only (72.3%) compared with women without genital HSV-2 infection (42.4%) (P = 0.004). Women with genital HSV-2 infection had higher median cervicovaginal HIV-1-RNA loads (3.14 log10 copies/mL versus 2.10 log10 copies/mL; P = 0.003), higher plasma HIV-1-RNA loads (median 5.10 versus 4.65 log10 copies/mL; P = 0.07), and lower median CD4 cell counts) (198 versus 409 cells/mm, P = 0.03). Cervicovaginal HIV-1 RNA and HSV-2 DNA were significantly correlated after adjusting for plasma HIV-1 RNA and CD4 cell counts (P < 0.001) and a 10-fold increase in cervicovaginal HSV-2 DNA was associated with a 1.7-fold increase in plasma HIV-1 RNA (P = 0.003).

Conclusion: Genital HSV-2 infection is associated with increased cervicovaginal and plasma HIV-1 RNA among co-infected women with genital ulcers, independently of the level of immunodeficiency, highlighting the close interaction between these two viruses and the role of HSV-2 as a co-factor for the sexual transmission of HIV-1.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acyclovir / therapeutic use
  • Adolescent
  • Adult
  • Aged
  • Antiviral Agents / therapeutic use
  • CD4 Lymphocyte Count
  • Cervix Uteri / virology
  • DNA, Viral / analysis
  • Female
  • HIV Infections / complications*
  • HIV Infections / immunology
  • HIV Infections / transmission
  • HIV Infections / virology
  • HIV-1 / isolation & purification*
  • Herpes Genitalis / complications*
  • Herpes Genitalis / drug therapy
  • Herpes Genitalis / virology
  • Herpesvirus 2, Human / isolation & purification*
  • Humans
  • Middle Aged
  • RNA, Viral / analysis
  • RNA, Viral / blood
  • Vagina / virology
  • Viral Load
  • Virus Shedding*


  • Antiviral Agents
  • DNA, Viral
  • RNA, Viral
  • Acyclovir