Abstract
Herpes simplex virus type-2 (HSV2) infection increases HIV transmission. We explore the impact of a potential prophylactic HSV2 vaccination on HIV incidence in Africa using STDSIM an individual-based model. A campaign that achieved 70% coverage over 5 years with a vaccine that reduced susceptibility to HSV2 acquisition and HSV2 reactivation by 75% for 10 years, reduced HIV incidence by 30–40% after 20 years (range 4–66%). Over 20 years, in most scenarios fewer than 100 vaccinations were required to avert one HIV infection. HSV2 vaccines could have a substantial impact on HIV incidence. Intensified efforts are needed to develop an effective HSV2 vaccine.
Highlights
HIV and Herpes simplex virus type-2 (HSV2) have a synergistic relationship
We have previously shown that the magnitude of these per-contact cofactor effects give incidence rate ratios for the association between HIV and HSV2 prevalence, and PAFs of HIV incidence associated with HSV2, in line with empirical data [11,23,42,43]
This study shows that HSV2 vaccination could theoretically reduce HIV incidence sufficiently for a substantial public health impact
Summary
HIV affects HSV2 shedding, and the frequency and duration of clinical reactivations [1,2,3,4]. HSV2, in turn, has a strong impact on HIV transmission and acquisition, and may affect the natural history of HIV infection [3,5,6,7,8,9,10]. Two recent randomised-controlled trials of herpes suppressive therapy have failed to show an impact on HIV acquisition, perhaps because of insufficient herpes suppression due to drug dosage or inadequate adherence, or the mechanism of action of acyclovir does not reduce the role of HSV2 in HIV transmission [15,16]. HSV2 vaccines may provide a more effective means of HIV control
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