Abstract
ObjectiveTo examine herpes simplex virus 2 (HSV-2)/HIV co-infection as a contributing factor in the increase in HIV infection among non-injecting heroin and cocaine users in New York City.MethodsSubjects were recruited from the Beth Israel Medical Center drug detoxification and methadone maintenance programs in New York City in 1995–1999 and 2005–2011. All reported current heroin and/or cocaine use and no injection drug use. A structured questionnaire was administered and serum samples collected for HIV and HSV-2 testing. Population-attributable risk percentages (PAR%s) were estimated for associations between HSV-2 and increased susceptibility to and increased transmissibility of HIV among female NIDUs.Results785 subjects were recruited from 1995–1999, and 1764 subjects from 2005–2011. HIV prevalence increased from 7% to 13%, with nearly uniform increases among all demographic subgroups. HSV-2/HIV co-infection was common in both time periods, with an average (over the two time periods) of 80% of HIV negative females infected with HSV-2, an average of 43% of HIV negative males infected with HSV-2; an average of 97% of HIV positive females also infected with HSV-2 and an average of 67% of HIV positive males also infected with HSV-2. The increase in HIV prevalence was predominantly an increase in HSV-2/HIV co-infection, with relatively little HIV mono-infection in either time period. The estimated PAR%s indicate that approximately half of HIV acquisition among females was caused by HSV-2 infection and approximately 60% of HIV transmission from females was due to HSV-2 co-infection.ConclusionsThe increase in HIV infection among these non-injecting drug users is better considered as an increase in HSV-2/HIV co-infection rather than simply an increase in HIV prevalence. Additional interventions (such as treatment as prevention and suppressing the effects of HSV-2 on HIV transmission) are needed to reduce further HIV transmission from HSV-2/HIV co-infected non-injecting drug users.
Highlights
While injecting drug use is strongly associated with HIV in many parts of the world. [1], non-injecting drug use may lead to sexual transmission of HIV through several pathways
We examine the relationships between herpes simplex virus 2 (HSV-2) and HIV infection over a time period in which HIV prevalence doubled among non-injecting drug users in New York City
As we were interested in HIV infection due to heterosexual transmission, subjects reporting MSM behavior were not included in the analyses presented here. (A separate report on HSV-2 and HIV among subjects reporting MSM behavior is in preparation.)
Summary
While injecting drug use is strongly associated with HIV in many parts of the world. [1], non-injecting drug use may lead to sexual transmission of HIV through several pathways. [1], non-injecting drug use may lead to sexual transmission of HIV through several pathways. [2]; [3]; [4] A number of studies have found very high HIV prevalence among (predominantly heterosexual) non-injecting drug users (NIDUs): 37% in Porto Alegre, Brazil [5], 43% in China [6], 13% in Canada [7], 20% in Florida [8], 19% in New York City [9], 24% in Portugal [10], and 29% in Russia [11]. We examine the relationships between HSV-2 and HIV infection over a time period in which HIV prevalence doubled among non-injecting drug users in New York City. The relationship between HSV-2 and HIV infection has been extensively studied in sub-Saharan Africa [12]; [13]; [14], but there have been relatively few studies of the relationships between HSV-2 and HIV in the US [18]; [19]; [20]
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