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

AIDS. 2008 Jun 19;22(10):1169-76. doi: 10.1097/QAD.0b013e3282fec42a.

Abstract

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 log(10)copies/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.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Anti-HIV Agents / therapeutic use
  • Antibodies, Viral / analysis
  • Cervix Uteri / virology
  • DNA, Viral / analysis
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy
  • HIV Infections / transmission*
  • HIV-1*
  • Herpes Genitalis / complications
  • Herpes Genitalis / transmission*
  • Herpesvirus 2, Human / immunology
  • Herpesvirus 2, Human / isolation & purification*
  • Humans
  • Infectious Disease Transmission, Vertical
  • Polymerase Chain Reaction
  • Pregnancy
  • Pregnancy Complications, Infectious / prevention & control
  • Pregnancy Complications, Infectious / virology*
  • Vagina / virology
  • Viral Load
  • Virus Shedding / physiology
  • Zidovudine / therapeutic use

Substances

  • Anti-HIV Agents
  • Antibodies, Viral
  • DNA, Viral
  • Zidovudine