Nearly 500 women were randomized to daily acyclovir or placebo, seen quarterly, and followed-up for up to 24 months. On the other hand, HSV-2 IgM seroprevalence was significantly higher (p value < 0.005 by χ2 test) in the HIV patient group (34.6%) than the HIV control (2.2%) and non-HIV control (2.2%) group (Tables and ). Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) are the most common, and although it is often asymptomatic, such CMV and EBV replication is associated with higher levels of immune activation and HIV disease progression. In other studies, the frequent finding of serological evidence of infection with both viruses has pointed toward the likelihood that HSV, through the disruption of the genital epithelium, enhances the transmission and acquisition of HIV [4–6]. Results: The median CD4 cell count at study entry was 384 cells/mm3. The researchers also increases a strong link between visible genital ulcers caused by HSV-2 and recent HIV infection that is infected with a five risk times higher in HIV patients with visible ulcers, compared to a risk twice with chronic asymptomatic HSV-2. !
Multivariable logistic regressions were fit to identify independent predictors of transmission. Valacyclovir had no effect on CD4+ T-lymphocyte count or HIV viral load in this population. There was no difference in the number of HSV-2 shedders in the tenofovir and nontenofovir groups (59 vs. The impact of acyclovir/valacyclovir treatment on CD4 decline may be because of it reducing HIV-1 PVL but may also be because of its antiretroviral action reducing HIV-1 replication.13 However, because PVL is a major predictor of survival,14 it is plausible that reducing elevated PVLs because of other coinfections may have similar, if yet unquantified, effects. References for this review were identified through searches of PubMed and Google Scholar with no date restriction using the term HIV in combination with herpesviruses, cytomegalovirus, herpes simplex, immune activation, epidemiology, among others. ART was associated with a reduction in the odds of HSV-2 shedding, which declined for each year of ART use (odds ratio [OR], 0.74; 95% confidence interval [CI], .59–.92). Recent trials have shown that treating HSV/HIV-1 coinfection with acyclovir and valacyclovir reduces HIV-1 PVL, which may reduce infectiousness,2,3 and has now also been shown to decrease HIV-1 disease progression by decreasing the rate of CD4 cell count decline during asymptomatic HIV-1 infection.10–12 This delays the point at which antiretroviral therapy (ART) should be initiated but also provides more opportunities for onward HIV-1 spread.
There was a strong association between the 2 infections after adjustment for other factors (OR = 4.22, 95% CI: 2.6 to 6.9). In other studies, the frequent finding of serological evidence of infection with both viruses has pointed toward the likelihood that HSV, through the disruption of the genital epithelium, enhances the transmission and acquisition of HIV [4–6]. This result probably relates to current or historical factors, including racial and ethnic differences associated with poverty, access to health services, behaviors and practices related to health in general and to the sex and age composition of different population strata, and patterns of sexual behavior and affective interaction [1, 12]. The purpose of this chapter is to review the current knowledge on the relationship between HIV infection and menstrual abnormalities, genital neoplasias, contraceptive options, surgical complications, and menopause with its associated disorders. Secondly, there would or should be no stigma attached to the victim in the circumstances of Miss Scott, any more than any other innocent victim of a crime, but that has nothing to do with prosecuting the offender. These findings strongly suggest that recombinant HSV1 vectors expressing Tat merit further investigation for their potential to prevent and/or contain HSV1 infection and dissemination. Plasma (weekly) and endocervical swabs (thrice weekly) were collected for HIV-1 RNA PCR.
Progression to CD4≤200 cells/µl was similar between HSV-2-seropositive and seronegative women (HR 1.15, 95% CI: 0.52–2.53, P = 0.74), and changes in plasma HIV-1 RNA did not differ significantly by HSV-2 serostatus (Figure 2). HHV-6 positive febrile hospitalized infants had higher HIV-1, 57% (4/7), compared to asymptomatic infants, 3% (2/74). We know that persons with HSV-2 tend to have increased amounts of HIV in their blood as well. 36% (95% CI: 18-61%) of HIV infections among HSV-2-infected FSWs could have been averted if suppressive therapy reduced their risk of HIV acquisition to that of the HSV-2-uninfected FSWs. SEVERAL epidemiologic studies have shown an association between the acquisition of the human immunodeficiency virus 1 (HIV-1) and the reported presence of genital lesions in the presumed source contact.1- 6 In 1 study of discordant couples with HIV-1 infection, presence of a genital ulcer in the source partner was associated with a 5-fold greater risk in the transmission of HIV-1.7 Worldwide, the most common infectious etiologies of genital ulcers are herpes simplex virus (HSV), syphilis, and chancroid,8,9 with HSV the most common in North America and Europe, accounting for 75% to 80% of infectious genital ulcers.10 One of the first reports of a common source cluster of sexually transmitted HIV-1 infection in Europe emanated from an HIV-1–infected individual who on retrospective questioning was noted to have genital HSV-2 infection.4 Recent studies have shown that genital herpes is the most frequent sexually transmitted disease among HIV-1–seropositive persons,11 and most HSV-2–seropositive persons (whether HIV-1 infected or immunocompetent) intermittently reactivate the virus on mucosal surfaces.12- 14 Clinically, HSV-2 causes lesions that are smaller and of shorter duration than those caused by chancroid or syphilis, and HSV-2 ulcerations often occur in locations difficult to visualize, such as the cervix or perineal region.13,15 As such, the true prevalence of clinically described genital lesions due to HSV among persons suspected of transmitting HIV-1 is likely to be underestimated.