High prevalence of herpes simplex virus (HSV)- type 2 co-infection among HIV-positive women in Ukraine, but no increased HIV mother-to-child transmission risk.

Karoline Aebi-Popp,Ruslan Malyuta,Alla Volokha,Heather Bailey,Claire Thorne

doi:10.1186/s12884-016-0887-y

Abstract

BackgroundOver 3500 HIV-positive women give birth annually in Ukraine, a setting with high prevalence of sexually transmitted infections. Herpes simplex virus Type 2 (HSV-2) co-infection may increase HIV mother-to-child transmission (MTCT) risk. We explored factors associated with HSV-2 seropositivity among HIV-positive women in Ukraine, and its impact on HIV MTCT.MethodsData on 1513 HIV-positive women enrolled in the Ukraine European Collaborative Study from 2007 to 2012 were analysed. Poisson and logistic regression models respectively were fit to investigate factors associated with HSV-2 seropositivity and HIV MTCT.ResultsMedian maternal age was 27 years (IQR 24–31), 53 % (796/1513) had been diagnosed with HIV during their most recent pregnancy and 20 % had a history of injecting drugs. Median antenatal CD4 count was 430 cells/mm3 (IQR 290–580). Ninety-six percent had received antiretroviral therapy antenatally. HSV-2 seroprevalence was 68 % (1026/1513). In adjusted analyses, factors associated with HSV-2 antibodies were history of pregnancy termination (APR 1.30 (95 % CI 1.18–1.43) for ≥2 vs. 0), having an HIV-positive partner (APR 1.15 (95 % CI 1.05–1.26) vs partner’s HIV status unknown) and HCV seropositivity (APR 1.23 (95 % CI 1.13–1.35)). The overall HIV MTCT rate was 2.80 % (95 % CI 1.98–3.84); no increased HIV MTCT risk was detected among HSV-2 seropositive women after adjusting for known risk factors (AOR 1.43 (95 % CI 0.54–3.77).ConclusionNo increased risk of HIV MTCT was detected among the 68 % of HIV-positive women with antibodies to HSV-2, in this population with an overall HIV MTCT rate of 2.8 %. Markers of ongoing sexual risk among HIV-positive HSV-2 seronegative women indicate the importance of interventions to prevent primary HSV-2 infection during pregnancy in this high-risk group.

Highlights

Over 3500 human immunodeficiency virus (HIV)-positive women give birth annually in Ukraine, a setting with high prevalence of sexually transmitted infections
The 1513 HIV-positive women with Herpes simplex virus Type 2 (HSV-2) serostatus available were enrolled into the postnatal cohort a median of 3.9 months (interquartile range (IQR) 1.1–10.3) after delivery
In our adjusted analyses we found that HSV-2 seropositive women were more likely to have a history of pregnancy termination, which may be a marker of greater sexual risk, including lack of or inconsistent use of barrier contraception

Summary

Introduction

Over 3500 HIV-positive women give birth annually in Ukraine, a setting with high prevalence of sexually transmitted infections. During latency HSV-2 is able to avoid clearance by the immune system, but laboratory tests show specific antibodies and it can cause recurrent activations, which are more common and of longer duration with HIV co-infection [7, 8]. This synergistic relationship between HIV and HSV-2 results in more frequent subclinical episodes of HSV-2 reactivation in HIV-positive individuals, which seems to be associated with increases in plasma and genital tract HIV viral load [9]

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Conclusion