Abstract
BackgroundHerpes simplex virus type 2 (HSV-2), one the most common causes of genital ulcers, appears to increase both the risk of HIV acquisition and HIV transmission. HSV-2/HIV co-infection among pregnant women may increase the risk of perinatal transmission of HIV. This study describes rates of HSV-2 among pregnant women in Haiti and HSV-2 test performance in this population.MethodsUnlinked residual serum specimens from the 2012 National HIV and Syphilis Sentinel Surveillance Survey among pregnant women in Haiti were tested using two commercial kits (Focus HerpeSelect, Kalon) for HSV-2 antibodies. We evaluated rates of HSV-2 seropositivity and HSV-2/HIV co-infection, associations between HSV-2 and demographic characteristics using multivariable Cox proportional hazards modeling, and HSV-2 test performance in this population.ResultsSerum samples from 1000 pregnant women (all 164 HIV positive and 836 random HIV negative) were selected. The overall weighted prevalence of HSV-2 was 31.4% (95% CI: 27.7–35.4) and the prevalence of HIV-positivity among HSV-2 positive pregnant women was five times higher than the prevalence among HSV-2 negative women (4.8% [95% CI: 3.9–6.0] vs. 0.9% [95% CI: 0.6–1.3], respectively). Factors significantly associated with HSV-2 positivity were HIV-positivity (PR: 2.27 [95% CI: 1.94–2.65]) and older age (PRs: 1.41 [95% CI: 1.05–1.91] for 20–24 years, 1.71 [95% CI:1.13–2.60] for 30–34 years, and 1.55 [95% CI: 1.10–2.19] for 35 years or greater]), while rural residence was negatively associated with HSV-2 positivity (PR 0.83 [95% CI: 0.69–1.00]), after controlling for other covariables. For this study a conservative Focus index cutoff of 3.5 was used, but among samples with a Focus index value ≥2.5, 98.4% had positive Kalon tests.ConclusionThe prevalence of HSV-2 is relatively high among pregnant women in Haiti. Public health interventions to increase access to HSV-2 screening in antenatal services are warranted.
Highlights
Herpes simplex virus type 2 (HSV-2), one the most common causes of genital ulcers, appears to increase both the risk of Human Immunodeficiency VirusHSV-2Herpes Simplex Virus type 2 (HIV) acquisition and HIV transmission
Those living in rural environments had significantly lower prevalence of HSV-2 when compared to those living in urban environments, after controlling for all other variables (PR: 0.83, [Confidence Interval (CI): 0.69–1.00], p = 0.047)
HIV positivity was associated with 2.27-fold increase in prevalence of HSV-2, when compared to those who were HIV negative, after controlling for all other factors ([CI: 1.94– 2.65], p < 0.001)
Summary
Herpes simplex virus type 2 (HSV-2), one the most common causes of genital ulcers, appears to increase both the risk of HIV acquisition and HIV transmission. HSV-2/HIV co-infection among pregnant women may increase the risk of perinatal transmission of HIV. Transmitted infections that cause inflammation or ulcerative genital lesions have long been identified as among the greatest risk factors for HIV infection [1, 4], and infection with HSV-2 has been strongly associated with HIV infection [2, 4, 5]. HSV-2 appears to increase both the risk of HIV acquisition and the potential for a co-infected individual to transmit HIV to sexual partners [2, 5]. Since most HSV-2 infections are acquired sexually, rates of HSV-2 seropositivity can provide information about sexual activity at the population level and risk of HIV at the individual level [12]
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