Roles of clinical and subclinical reactivated herpes simplex virus type 2 infection and human immunodeficiency virus type 1 (HIV-1) -induced immunosuppression on genital and plasma HIV-1 levels
Nagot, N.; Ouedraogo, A.; Konate, I.; Weiss, H.A.; Foulongne, V.; Defer, M.C.; Sanon, A.; Becquart, P.; Segondy, M.; Sawadogo, A.; Van de Perre, P.; Mayaud, P.; Bahembera, E.; Berthe, A.; Coulibaly, M.; Defer, M.-C.; Diallo, R.; Djagbare, D.; Konate, I.; Ky-Dama, F.; M'Boutiki, G.T.; Meda, N.; Millogo, I.; Ouedraogo, A.; Ouedraogo, D.; Rouet, F.ço.; Sanon, A.; Sawadogo, H.; Vallo, R.; Andonaba, J.-B.; Sawadogo, A.; Mayaud, P.; Weiss, H.A.; Nagot, N.; Becquart, P.; Foulongne, V.; Segondy, M
Journal of Infectious Diseases 198(2): 241-249
2008
ISSN/ISBN: 0022-1899 PMID: 18593294 DOI: 10.1086/589621Document Number: 201672
Few longitudinal studies have described the interactions between reactivation of herpes simplex virus type 2 (HSV-2) infection (hereafter, "HSV-2 reactivation") and genital and systemic replication of human immunodeficiency virus type 1 (HIV-1). Women in Burkina Faso who were seropositive for both HIV-1 and HSV-2 were enrolled in a randomized placebo-controlled trial of therapy to suppress reactivation of HSV-2 infection (hereafter, "HSV suppressive therapy"). During the baseline phase, 6 enriched cervicovaginal lavage specimens were obtained over 12 weeks to detect and quantify the HIV-1 RNA and HSV-2 DNA loads. Women with genital ulcer disease (GUD) detected at least once were more likely than women in whom GUD was not detected (risk ratio [RR], 1.23; 95% confidence interval [CI], 1.09-1.37) to have genital HIV-1 RNA detected during >or=1 visit. Similarly, women with genital HSV-2 DNA detected during >or=1 clinic visit were more likely than women in whom genital HSV-2 DNA was not detected (RR, 1.17; 95% CI, 1.01-1.34) to have genital HIV-1 RNA detected at least once. In addition, the mean genital HIV-1 RNA loads for women with GUD detected during >or=1 visit and women with HSV-2 genital shedding detected during >or=1 visit were greater than that for women in whom genital HSV-2 DNA or GUD was never detected. The plasma HIV-1 RNA load was increased among women for whom >or=1 visit revealed GUD (+0.25 log(10) copies/mL; 95% CI, -0.05-0.55) or genital HSV-2 DNA (+0.40 log(10) copies/mL; 95% CI, 0.15-0.66), compared with women who did not experience GUD or HSV-2 genital shedding, respectively. The association of HSV-2 reactivations on HIV-1 replication tended to be stronger in patients with a higher CD4(+) cell count (i.e., >500 cells/microL). The contribution of HSV-2 to HIV-1 replication among women with CD4(+) cell count of