High seroprevalence of human herpesviruses in HIV-infected individuals attending primary healthcare facilities in rural South Africa.

Erik Schaftenaar,Georges M G M Verjans,Remco P H Peters,James A Mcintyre,Sarah Getu,Helen E Struthers,Albert D M E Osterhaus

doi:10.1371/journal.pone.0099243

Erik Schaftenaar, Georges M G M Verjans + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0099243

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Abstract

Seroprevalence data of human herpesviruses (HHVs) are limited for sub-Saharan Africa. These are important to provide an indication of potential burden of HHV-related disease, in particular in human immunodeficiency virus (HIV)-infected individuals who are known to be at increased risk of these conditions in the Western world. In this cross-sectional study among 405 HIV-infected and antiretroviral therapy naïve individuals in rural South Africa the seroprevalence of HHVs was: herpes simplex virus type 1 (HSV-1) (98%), herpes simplex virus type 2 (HSV-2) (87%), varicella zoster virus (VZV) (89%), and 100% for both Epstein-Barr virus (EBV) and cytomegalovirus (CMV). Independent factors associated with VZV seropositivity were low educational status and having children. Lack of in-house access to drinking water was independently associated with positive HSV-1 serostatus, whereas Shangaan ethnicity was associated with HSV-2 seropositivity. Increasing age was associated with higher IgG titres to both EBV and CMV, whereas CD4 cell count was negatively associated with EBV and CMV IgG titres. Moreover, IgG titres of HSV-1 and 2, VZV and CMV, and CMV and EBV were positively correlated. The high HHV seroprevalence emphasises the importance of awareness of these viral infections in HIV-infected individuals in South Africa.

Highlights

Herpes simplex virus type 1 (HSV-1) and 2 (HSV-2), varicella zoster virus (VZV), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) are human herpesviruses (HHV) that are prevalent worldwide
Thirty (8%) participants were newly diagnosed for human immunodeficiency virus (HIV) infection, 354 (87%) attended the ‘wellness, pre-antiretroviral therapy (ART) programme’ and 21 (5%) individuals attended the clinic for baseline results before ART initiation
This study reports on the seroprevalence of HSV-1, herpes simplex virus type 2 (HSV-2), VZV, EBV and CMV among HIV-infected and ART-naıve adults in rural South Africa

Summary

Introduction

Herpes simplex virus type 1 (HSV-1) and 2 (HSV-2), varicella zoster virus (VZV), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) are human herpesviruses (HHV) that are prevalent worldwide. HHV infections clinically interact with HIV, contribute substantially to hospitalization, morbidity and mortality and some HHVs (e.g. HSV-2) may even facilitate HIV transmission [4,7,8] This is of particular importance in sub-Saharan Africa where HIV prevalence rates are at their highest. In contrast to developed countries, where HHV seroprevalence and occurrence of associated diseases are well-documented, there is only scarce information available on the seroprevalence and risk factors of HHV infections in sub-Saharan Africa. This information is important to provide an indication of the burden of HHV infections which is relevant for HIV-infected individuals who are known to be at increased risk for development of HHV-induced disease due to reactivation

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