HSV-2 as a biomarker of HIV epidemic potential in female sex workers: meta-analysis, global epidemiology and implications

Hiam Chemaitelly,Laith J. Abu-Raddad,Helen A. Weiss

doi:10.1038/s41598-020-76380-z

Abstract

This study investigated herpes simplex virus type 2 (HSV-2) seroprevalence utility as a predictor of HIV epidemic potential among female sex workers (FSWs) globally. We updated and analyzed a systematically-assembled database for paired HSV-2 and HIV seroprevalence measures among FSWs. The study identified 231 paired HSV-2/HIV prevalence measures from 40 countries. The pooled mean HIV prevalence using meta-analysis increased from 3.7% (95% CI 0.3–9.9%) among populations of FSWs with HSV-2 prevalence < 25% to 18.7% (95% CI 14.1–23.8%) among those with HSV-2 prevalence 75–100%. HIV prevalence was negligible in FSWs with HSV-2 prevalence ≤ 20% suggesting a threshold effect. Multivariable meta-regressions explained > 65% of HIV prevalence variation, and identified a strong positive HSV-2/HIV association. Compared to populations of FSWs with HSV-2 prevalence < 25%, adjusted odds ratios (AORs) of HIV infection increased from 2.8 (95% CI 1.2–6.3) in those with HSV-2 prevalence 25–49%, to 13.4 (95% CI 6.1–29.9) in those with HSV-2 prevalence 75–100%. HSV-2 is a strong predictor of HIV epidemic potential among FSWs. HSV-2 prevalence of 25–49% indicates potential for intermediate-intensity HIV epidemics, with higher levels indicative of large epidemics. HSV-2 surveillance could inform HIV preparedness in countries where HIV prevalence among FSWs is still limited or at zero-level.

Highlights

Female sex workers (FSWs) continue to be a vulnerable and stigmatized population that is disproportionately affected by H IV1–3
Motivated by the concept of using current herpes simplex virus type 2 (HSV-2) prevalence in a population as a proxy biomarker of future HIV prevalence in that population[8,9,20] and its relevance to HIV preparedness, this study assessed the utility of HSV-2 as a predictor of HIV epidemic potential among female sex workers (FSWs) through a global systematic analysis of empirical paired HSV-2 and HIV prevalence measures
HIV prevalence was negligible at HSV-2 prevalence ≤ 20% (Fig. 2), but increased steadily with higher HSV-2 prevalence suggesting a threshold effect—the odds of HIV infection doubled with a 25% increase in HSV-2 prevalence (Tables 1 and 2)

Summary

Introduction

Female sex workers (FSWs) continue to be a vulnerable and stigmatized population that is disproportionately affected by H IV1–3. Epidemic potential is unknown for half of EMRO countries where studies have consistently assessed HIV prevalence among FSWs at zero or negligible levels, but where documented overlap with other at-risk populations may create opportunities for seeding epidemics[5]. Since herpes simplex virus type 2 (HSV-2) is almost exclusively sexually transmitted, is more transmissible than HIV, and produces long-lasting antibodies, it has been used as a biological marker of sexual risk and objective indicator of the risk of exposure to HIV8,9,13–15. It is believed, based on observational evidence, that there is an epidemiologic synergy between HSV-2 and HIV infection[16,17,18], though recent evidence has casted doubt about this synergy[19]. The recent emergence and steady growth of HIV epidemics among FSWs in different EMRO countries, after years of limited or no prevalence, advocate for the relevance and urgency of collecting such data to enable assessment of HIV epidemic potential in these s ettings[5]

Methods

Results

Conclusion