Prevalence Of HSV-2 Research Articles

Molecular detection and association of HIV and HSV-2 IgM co-infection among asymptomatic pregnant women in Port Harcourt, Nigeria

HSV-2 is a common human pathogen that can cause primary and recurrent infection of the mucous membrane. Genital infection with HSV-2 facilitates the acquisition of HIV, both mutually reinforcing infection. Infection with herpes simplex virus type 2 is a significant public health problem being the leading cause of genital ulcerative disease. This study aimed at Molecular investigation and association of HIV and HSV-2 IgM co-infection among asymptomatic pregnant women in Port Harcourt, Nigeria. This is a cross-sectional study conducted at the antenatal unit of the University of Port Harcourt Teaching Hospital (UPTH), River State. A total of 168 consenting pregnant women were selected. The study involved collecting socio-demographic data and laboratory determination of HSV-2 immunoglobulin M (IgM) and HIV seroprevalence using enzyme linked immunosorbent assay (DIAPRO Diagnostic Bioprobes, Milan, Italy) and ALERE determine/STAT PAK respectively. Data analysis was done using graph pad statistical package. Chi square analysis was used to determine the correlation of the infection with socio-demographic factors. The seroprevalence for HSV-2 IgM was 29.8% (50/168) of the respondents while there was no co-infection between IgM and HIV. All HIV respondents were married. Majority are trader having tertiary educational qualification and are in a monogamous relationship. With regard to IgM seropositivity age, marital status, religion and gestation period were significantly associated with IgM while educational level, occupation, type of family and parity were not significantly associated with HSV-2 IgM. There is a significant correlation between HIV seropositivity with parity and history of sexually transmitted disease while there is no significant difference between HIV prevalence with age, marital status education level occupation type of family, religion history of abortion and the prevalence of HSV-2 was high among women of childbearing age in Port Harcourt, Nigeria. Effort should be made to increase the awareness of HSV-2 and HIV infection among the childbearing populace and serological testing of pregnant women should be included as a routine test.

Prevalence of herpes simplex virus and associated risk factors among female students of natural and applied science, Nasarawa state university, Keffi

Herpes Simplex Type 2 Viruses (HSV-2) are one of the most common viral sexually transmitted diseases worldwide, which are now a significant health concern. This study aim at prevalence of herpes simplex virus type 2 IgG and IgM and the associated risk factors among female students of Natural and Applied Science, Nasarawa State University, Keffi. Blood samples were collected from 150 female students of Natural and Applied Science. The socio-demographic information of the participants was collected by using a structured questionnaire. The sera samples were screened for IgGand IgM using NADALR HSV-2 IgG/IgM Rapid Antibody Test Cassette (Bulgarian Company for Biotechnology). The overall prevalence of HSV-2 IgG/IgM was 3.3% and 2.6%. The occurrence HSV-2 IgG in relation to the Age was high among age 26-30 years (100 %) and least among 21-25 years (2.0 %). The occurrence of HSV-2 IgM in relation to the Age was high among age 16-20 years (2.9 %) and least among was 21-25 years (2.0 %). the total prevalence of co-occurrence of HSV-2 IgG/IgM was 1.3%. the prevalence of In relation to knowledge of HSV-2 IgG and IgM in relation knowledge of HSV-2 infection was highest with no knowledge of HSV-2 recorded the IgG 4.5% and 3.4% with IgM. In relation to history of STI participants with history of STI recorded highest in IgG (23.5 %) and IgM (2.7 %). In relation to sharing sanitary facilities participants that share sanitary facilities recorded highest IgG 5.7% and IgM those that don’t share sanitary recorded highest 3.0 %. The prevalence of the HSV-2 infections was high among female students of Natural and Applied Science.

Detection of herpes simplex viruses in the oral lesions of patients with pemphigus vulgaris: Is it diagnostic or predictive of disease severity?

Some studies emphasise the relationship between the herpes simplex virus (HSV) and pemphigus. Although the possible role of HSV in the pathogenesis of pemphigus and the severity of the disease is obscure, we aimed to evaluate the presence of herpes simplex viruses (HSV 1/2) in the oral lesions of patients with pemphigus vulgaris and also assess its association with disease severity and types of lesions. A retrospective study was conducted on collected data in the form of collecting paraffin blocks, slides, and relevant pathology reports and referring to patients' medical records. A questionnaire containing details on the degree of skin, scalp, and mucosal involvement (Pemphigus Disease Area Index (PDAI)) was fulfiled. The immunoassay result was also collected to check the anti-desmoglein 3 and 1 antibodies (using ELISA technique). In this study, 52 patients of pemphigus vulgaris with oral lesions (case) and 52 patients with oral lesions not related to the disease (control) were evaluated. HSV1 was detected in 13.5% of oral pemphigus lesions and 1.9% of the control group (p=0.0598). There were no positive cases of HSV2 in either group. There was no significant association between the positivity of HSV1 and the site of lesions (p=1.00) or disease severity (p=0.28). However, we found a strong correlation between the PDAI disease severity score with the titre of the AntiDsg3 antibody (r=0.487, p=0.001) and AntiDsg1 antibody (r=0.309, p=0.026). This study demonstrated a significant prevalence of HSV1 in oral pemphigus lesions, and acyclovir therapy may play a significant role in managing these patients. However, HSV's role in the pathogenesis of pemphigus vulgaris cannot be clearly determined.

Low Prevalence of HSV-1 and Helicobacter pylori in HNSCC and Chronic Tonsillitis Patients Compared to Healthy Individuals.

Recent studies identified viral and bacterial factors, including HSV-1 and H. pylori, as possible factors associated with diseases such as chronic tonsillitis and cancers, including head and neck squamous cell carcinoma (HNSCC). We assessed the prevalence of HSV-1/2 and H. pylori in patients with HNSCC, chronic tonsillitis, and healthy individuals using PCR after DNA isolation. Associations were sought between the presence of HSV-1, H. pylori, and clinicopathological and demographic characteristics and stimulant use. HSV-1 and H. pylori were most frequently identified in controls (HSV-1: 12.5% and H. pylori: 6.3%). There were 7 (7.8%) and 8 (8.6%) patients with positive HSV-1 in HNSCC and chronic tonsillitis patients, respectively, while the prevalence of H. pylori was 0/90 (0%) and 3/93 (3.2%), respectively. More cases of HSV-1 were observed in older individuals in the control group. All positive HSV-1 cases in the HNSCC group were associated with advanced tumor stage (T3/T4). The prevalence of HSV-1 and H. pylori was highest in the controls compared to HNSCC and chronic tonsillitis patients, which indicates that the pathogens were not risk factors. However, since all positive HSV-1 cases in the HNSCC group were observed only in patients with advanced tumor stage, we suggested a possible link between HSV-1 and tumor progression. Further follow-up of the study groups is planned.

Molecular and Serological Epidemiology of Herpes Simplex Virus Type 1 and 2 in Pregnant Women of Gorgan City, North East of Iran.

As one of the most widespread sexually transmitted infections, Herpes Simplex Virus (HSVs) globally account for 60-95% of persistent infections in adults. This infection is prevalent in women of gestational age and is likely to be transmitted from the infected mother to her neonate. Additionally, it gives rise to devastating complications in neonates. This study was designed to estimate the molecular and serological prevalence of HSV-1 and 2 in pregnant women of Gorgan city, North East of Iran. Vaginal secretions and blood specimens of 315 pregnant women referred to an educational hospital in the North east of Iran were tested for HSV-1 and HSV-2 using multiplex PCR and ELISA assays. Chi-Square test was utilized to evaluate the association of qualitative variables and the level of significance was set at p≤0.05. Moreover, statistical analysis was performed using SPSS V.19.0. HSV-1 and HSV-2 DNA was detected in 5.7% and 8.3% of participants, respectively. Given the serological analyses of total HSV-1 and HSV-2 antibodies, 92.7% (239/315) of patients were IgG positive and 5.4% (17/315) were IgM positive. The rate of HSV-1 and 2 in the present study was lower than that reported by World Health Organization (WHO). This study emphasizes the conduction of further investigations on HSVs since these viruses are probably playing significant role in sexually transmitted infections.

Systematic review with meta-analysis of active herpesvirus infections in patients with COVID-19: Old players on the new field

Herpesviruses are ubiquitous and after primary infection they establish lifelong latency. The impairment of maintaining latency with short-term or long-term consequences could be triggered by other infection. Therefore, reactivation of herpesviruses in COVID-19 patients represents an emerging issue. This study provided the first systematic review with meta-analysis of studies that evaluated active human herpesvirus (HHV) infection (defined as the presence of IgM antibodies or HHV-DNA) in COVID-19 patients and included 36 publications collected by searching through PubMed, SCOPUS, and Web of science until November 2022. The prevalence of active EBV, HHV6, HSV, CMV, HSV1, and VZV infection in COVID-19 population was 41% (95% CI =27%-57%), 3% (95% CI=17%-54%), 28% (95% CI=1%-85%), 25% (95% CI=1%-63%), 22% (95% CI=10%-35%), and 18% (95% CI=4%-34%), respectively. There was a 6 times higher chance for active EBV infection in patients with severe COVID-19 than in non-COVID-19 controls (OR=6.45, 95% CI=1.09-38.13, p=0.040), although there was no difference in the prevalence of all evaluated active herpesvirus infections between COVID-19 patients and non-COVID-19 controls. Future research of herpesvirus and SARS-CoV-2 coinfections must be prioritized to define: who, when and how to be tested, as well as how to effectively treat HHVs reactivations in acute and long COVID-19 patients.

A novel microarray-based PCR assay for the detection of HSV-1, HSV-2, and VZV skin infections: A retrospective analysis

Prevalence of HSV-1, HSV-2, and VZV infection ranges from 20% to 90%. Viral reactivation is common and results in a significant individual and socioeconomic burden. Pathognomonic skin manifestations are not always present, impairing definitive clinical diagnosis. We evaluated the performance of a novel microarray-based multiplex PCR system (Euroarray, Euroimmun Medizinische Labordiagnostika) for the molecular detection of these pathogens. In this retrospective study, 50 consecutive specimens positive for HSV-1, HSV-2, or VZV (pre-characterized by qPCR) were analyzed. Two hundred-and-five negative test results were applied as a control group. The microarray successfully detected the respective pathogens in all samples that yielded a qPCR quantifiable amount of DNA. Two and one specimens containing VZV and HSV-1 DNA beneath the limit of quantification tested microarray negative. Microarray specificity was 100%. The microarray is a useful tool for diagnosing viral infections of skin and mucous membranes, allowing rapid differentiation between three pathogens in a single assay.

Herpes simplex virus infection in Bulgarian patients with neurological diseases

BackgroundHerpes simplex virus (HSV) seroprevalence in Bulgaria is higher than that in other countries but there is no information concerning involvement of these viruses in neuropathology. The aim of the present study was to determine the frequency of HSV DNA detection in cerebrospinal fluid (CSF) of patients with neurological diseases. MethodsThis study is a retrospective survey of test results obtained from January 2015 to October 2019. During this period 617 CSF specimens were tested for the presence of HSV-1 and/or HSV-2 DNA by PCR. ResultsOf all 612 CSF samples tested for HSV-1, 16.5% were positive. Of 547 CSF samples tested for HSV-2, 6.2% were positive. Co-infection with HSV-1 and HSV-2 was detected in 1.3% of tested 543 CSF samples. The difference of HSV-1 and/or HSV-2 prevalence in CSF of patients according to the gender and age was not statistically significant. The highest HSV-1 prevalence (25%) was detected in CSF from patients with multiple sclerosis (MS), followed by patients with encephalitis (20.6%). The highest HSV-2 prevalence (22.2%) was detected in CSF from patients with myelitis, followed by patients with encephalopathies (7.5%). ConclusionOur results show a considerable prevalence of HSV-1 and HSV-2 in CSF of patients with neurological diseases indicating the important role of these viruses in neuropathology in Bulgaria. HSV-1 is with predominant role in development of both encephalitis and meningitis in different age groups. Testing of CSF for HSV should be indispensable part of diagnostic algoritm of these diseases.

Evaluation between vitamin D serum level and Herpes Simplex Virus Type 1 in the field of dentistry

Objectives: Our study sought to evaluate the association between HSV1 and serum 25-hydroxyvitamin D (25(OH) D) levels among dental students. Materials & Methods: This is a cross-sectional study with a quantitative approach conducted in Birjand, state of Khorasan Jonoobi, Iran, from July 2018 to April 2019. A peripheral blood sample (5 ml) and an anti-virus antibody along with Serum 25-hydroxyvitamin D (1,25(OH)2D3) levels were measured using an Anti-Herpes-1 IgG kit with ELISA by a pathologist. Pearson and chi-square tests were applied in the significance level of 5%. Results: The prevalence of HSV1 was 41%. The serum 25-hydroxyvitamin D3 levels mean was 23.22 ± 13.09. The prevalence of HSV1 antibody in pre-clinical and clinical levels was higher than in basic science, also, the results represented that a negative relation between vitamin D deficiency and the presence of HSV1, but it was not a significant association. Conclusion: Any association between vitamin D and herpes viruses remains inconclusive. Further studies in the general population are needed.

Association of medical male circumcision and sexually transmitted infections in a population-based study using targeted maximum likelihood estimation

BackgroundEpidemiological theory and many empirical studies support the hypothesis that there is a protective effect of male circumcision against some sexually transmitted infections (STIs). However, there is a paucity of randomized control trials (RCTs) to test this hypothesis in the South African population. Due to the infeasibility of conducting RCTs, estimating marginal or average treatment effects with observational data increases interest. Using targeted maximum likelihood estimation (TMLE), a doubly robust estimation technique, we aim to provide evidence of an association between medical male circumcision (MMC) and two STI outcomes.MethodsHIV and HSV-2 status were the two primary outcomes for this study. We investigated the associations between MMC and these STI outcomes, using cross-sectional data from the HIV Incidence Provincial Surveillance System (HIPSS) study in KwaZulu-Natal, South Africa. HIV antibodies were tested from the blood samples collected in the study. For HSV-2, serum samples were tested for HSV-2 antibodies via an ELISA-based anti-HSV-2 IgG. We estimated marginal prevalence ratios (PR) using TMLE and compared estimates with those from propensity score full matching (PSFM) and inverse probability of treatment weighting (IPTW).ResultsFrom a total 2850 male participants included in the analytic sample, the overall weighted prevalence of HIV was 32.4% (n = 941) and HSV-2 was 53.2% (n = 1529). TMLE estimates suggest that MMC was associated with 31% lower HIV prevalence (PR: 0.690; 95% CI: 0.614, 0.777) and 21.1% lower HSV-2 prevalence (PR: 0.789; 95% CI: 0.734, 0.848). The propensity score analyses also provided evidence of association of MMC with lower prevalence of HIV and HSV-2. For PSFM: HIV (PR: 0.689; 95% CI: 0.537, 0.885), and HSV-2 (PR: 0.832; 95% CI: 0.709, 0.975). For IPTW: HIV (PR: 0.708; 95% CI: 0.572, 0.875), and HSV-2 (PR: 0.837; 95% CI: 0.738, 0.949).ConclusionUsing a TMLE approach, we present further evidence of a protective association of MMC against HIV and HSV-2 in this hyper-endemic South African setting. TMLE has the potential to enhance the evidence base for recommendations that embrace the effect of public health interventions on health or disease outcomes.

The evaluation of Human papilloma virus and human herpes viruses (EBV, CMV, VZV HSV-1 and HSV-2) in semen samples.

There are a number of risk factors, especially viral diseases, which can lead to infertility. Among the various viral infections, much attention has been given to the role of the Papillomaviridae and Herpesviridae. After collecting 82 semen samples (37 teratospermia, 2 asthenozoospermia, 2 oligoasthenospermia, 1 oligospermia, 6 asthenoteratospermia and 34 normal semen samples), and washing them, the DNA from both freshly ejaculated spermatozoon and washed spermatozoa was extracted. Subsequently, the prevalence of EBV, CMV, HSV-1, HSV-2, VZV and HPV was evaluated using Multiplex PCR and Nested PCR. In this study, 1 normal and 5 abnormal semen samples were infected with HSV-1 (1 normal, 4 teratospermia and 1 oligoasthenospermia). In addition, there were 2 VZV-positive samples (both were teratozoospermia). Nested PCR indicated that 1 asthenozoospermia, 1 asthenoteratospermia, 3 teratospermia and 4 normal samples were HPV positive (including 8 HPV-18 and 1 HPV-33). Among 9 HPV-positive subjects, 3 samples were negative after washing the infected samples. The prevalence of EBV, CMV, VZV, HSV-1 and HSV-2 remained unchanged prior to and after washing. Maybe sperm washing can be useful to eliminate HPV infection from semen samples, but further investigation is required because of the small number of samples.

Seroprevalence and characterisation of herpes simplex virus from human immunodeficiency virus in samples collected from the North-West and KwaZulu-Natal Provinces: a retrospective study.

Background: Herpes simplex viruses (HSVs) are highly pervasive and show a strongsynergistic interaction with human immunodeficiency virus (HIV). High prevalence of HSV type 1 (HSV-1) has been reported in Africa with a prevalence rate of 20-80% in women and 10-50% in men. Studies on the prevalence of HSV in South Africa are few considering the rate of HIV infection in the country. Our focus was to determine the molecular prevalence of HSV-DNA in HIV-1 sera. Methods: In total, 44 convenience samples were screened for HSV and HIV-1 using the highly sensitive enzyme-linked immunosorbent assay (ELISA). The ELISA positive samples were characterized using polymerase chain reaction (PCR) to confirm the positivity of both viruses and to further differentiate HSV into HSV-1 and -2. Thereafter, the samples were analysed for relatedness using phylogenetic analysis. Results: Of 44 samples, 36 (81.8%) were positive for HIV-1, while 35 (79.5%) were positive for HSV when screened with ELISA kits. The results of PCR with type specific primers showed that 4/35 (11.4%) samples were specific for HSV-1 while 30/35 (85.7%) were specific for HSV-2. Statistical analysis performed using chi-squared goodness-of-fit test showed that there is a significant relationship between HSV-2 and HIV-1 transmission. Conclusions: High prevalence of HSV-2 recorded in HIV-1 sera corroborate with similar studies conducted within different cohorts in the continent. SPSS Pearson's chi-squared test established that there is a significant relationship between HSV-2 and HIV-1 transmission.

Prevalence of HSV, Varicella-Zoster, CMV, Ebv and Hpv in the Oral Cavity and the Larynx Carcinoma in Iran

Introduction: Viral diseases can have roles in oral cavity and larynx carcinoma. However, the relationship between HPV, herpetic infection and these cancers is not clear. Materials & methods: DNA of tissues from oral and larynx carcinoma was extracted and the presence of HPV, HSV-1, HSV-2, EBV, CMV and Varicella Zoster virus was detected. Results: We detected five HSV-1 in oral cavity cancer and two HSV-1 in larynx carcinoma. Also, four and two HPV-positive in oral cavity and larynx carcinoma were found, respectively. There were five HPV type 18 and one HPV type 31. None of our samples were infected with EBV, CMV, HSV-2 and Varicella Zoster virus. Conclusion: A higher prevalence of HPV and HSV-1 in cancerous tissues in comparison with normal ones was detected.

Prevalence of Herpes Simplex Virus Infections in the Central Nervous System.

Central nervous system (CNS) infections may cause life-threatening meningitis, encephalitis, or brain abscesses. CNS infections are progressive and can cause permanent neurological damage. As such, prompt diagnosis and management are required. CNS infections are caused by bacterial, viral, and fungal pathogens. Herpes simplex viruses (HSV-1 and -2) are critical causative agents of CNS infections. The gold standard method to detect HSV-DNA in cerebrospinal fluid (CSF) and diagnose a CNS infection is the polymerase chain reaction (PCR). This study retrospectively investigated the prevalence of HSV-1 and -2 in patients hospitalized with suspected meningitis/encephalitis in Konya province using the multiplex real-time PCR method. A total of 525 CSF samples from patients hospitalized with suspected encephalitis/meningitis were tested between January 2015 and December 2017 using multiplex real-time PCR. Of the 525 CSF samples, 75% were from pediatric patients and 25% were from adult patients. The multiplex real-time PCR method (FTD NEURO9; Fast-Track Diagnostics, Esch-sur-Alzette, Luxembourg) was used to analyze the CSF samples. The presence of HSV-1 and -2 was measured qualitatively from the CSF samples. HSV-DNA was detected in 10 of 525 specimens (1.9%). While seven of these patients were infected with HSV-1, three were infected with HSV-2. Of the seven patients who were HSV-1-positive, two were children and five were adult patients. Two of the five HSV-1-positive adult patients were diagnosed with encephalitis. All three patients positive for HSV-2 were in the pediatric age group. While seven patients with positive HSV-1 results were identified in June, July, August, and September, three patients positive for HSV-2 were identified in December, January, and February. The prevalence of HSV-1 was 1.33% and the prevalence of HSV-2 was 0.57% in the region. Specific antiviral therapy significantly reduces the mortality and morbidity of CNS infections. Therefore, it is crucial to diagnose and treat HSV infections early. Rapid and sensitive identification of HSV with molecular methods to identify the local prevalence of HSV infection enables prophylactic measures against the virus so that infections can be effectively treated.

Prevalence of Herpes Simplex Virus type 2 IgM among Women of Reproductive Age in Zaria, and Demonstration of its Cytopathogenicity in Whole Egg

Egg culture has long been considered the diagnostic gold standard for Herpes Simplex Virus type 2 (HSV- 2) and would serve as complementary to Immunoglobulin M determination to establish acute infection in a given population. The study determined the prevalence of HSV-2 IgM and the cytopathology of the virus isolated from women of reproductive age in Zaria. The study recruited 450 consenting women attending selected hospitals from which blood and cervical swab samples were obtained. Sera were analysed for HSV-2 IgM while suspension from swabs were inoculated into 12 days old embryonated chicken eggs. A total of 330 (73.3%) women screened tested positive for HSV-2 IgM and 79 (23.94) out of 330 IgM positive samples produced cytopathic effect. The highest prevalence of 88.7% (133/150) was recorded among women recruited from St. Lukes Anglican hospital, while those attending Gambo Sawaba General Hospital-Kofan Gaya, had the lowest prevalence of 50%. Furthermore, women in age group of 16-20 years, were most infected with a prevalence of 83.5% while those aged 45years and above had the lowest prevalence of 50%. Women who had more than one sexual partner, those that did not use protection during sex and women that were pregnant had higher prevalence of 88.5%, 74.9% and 77.6% respectively and were more at risk, as compared with those with single partner (69.2%), who used protection (61.5%) and that were not pregnant (71.3%). About 22.4% (101) of the women reported to have heard about HSV-2 while 349 (77.6%) were not aware of the virus prior to this study. The symptoms found to be significantly associated with the virus were blisters/ulcers on genital area (p=0.000; OR=3.000) and dysuria (p=0.006; OR=0.504). Fever (OR=1.659), vaginal discharge (OR=1.867) and itching/burning sensation on genital area (OR=1.431) were other symptoms associated with the virus. The study demonstrated a high prevalence of HSV-2 among the women, indicating that, genital herpes is highly endemic in the study area. In addition, a substantial number of the women lacked knowledge of genital herpes and were actively harbouring the virus.

Seroprevalence of human alphaherpesvirus 1 and 2 among pregnant women infected or uninfected with Zika virus from Rio de Janeiro, Brazil.

Pregnant women are an important group to be monitored for infection due to the risk of transmitting infections to their babies. Both herpes simples virus (HSV) and Zika virus (ZIKV) are neurotropic viruses that can be transmitted congenitally. In this study, the prevalence and risk factors of HSV among Zika-positive and -negative pregnant women from Rio de Janeiro, Brazil, were evaluated and compared. About 167 serum samples included in our study were from pregnant women with ZIKV infection symptoms, who were attended to in different hospitals in Rio de Janeiro between November 2015 to February 2016. Blood samples collected from 167 pregnant women were used for this study. The presence of HSV antibodies and viremia were evaluated by commercial ELISA and quantitative real-time polymerase chain reaction analyses, respectively. The data obtained from medical records were statistically analyzed. The HSV-1 and HSV-2 prevalence among pregnant women was 80.2% and 12.5% for Zika-positive women and 84.5% and 5.6% for Zika-negative women, respectively. None of the pregnant women exhibited HSV viremia. Age, trimester of gestation, and skin color were associated with HSV-1 and HSV-2 prevalence among the groups studied. HSV-2 was more prevalent in Zika-positive pregnant women than in Zika-negative pregnant women, and this simultaneous infection should be better investigated in future studies.

Recent Out-of-Africa Migration of Human Herpes Simplex Viruses.

Herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) are ubiquitous human pathogens. Both viruses evolved from simplex viruses infecting African primates and they are thus thought to have left Africa during early human migrations. We analyzed the population structure of HSV-1 and HSV-2 circulating strains. Results indicated that HSV-1 populations have limited geographic structure and the most evident clustering by geography is likely due to recent bottlenecks. For HSV-2, the only level of population structure is accounted for by the so-called "worldwide" and "African" lineages. Analysis of ancestry components and nucleotide diversity, however, did not support the view that the worldwide lineage followed early humans during out-of-Africa dispersal. Although phylogeographic analysis confirmed an African origin for both viruses, molecular dating with a method that corrects for the time-dependent rate phenomenon indicated that HSV-1 and HSV-2 migrated from Africa in relatively recent times. In particular, we estimated that the HSV-2 worldwide lineage left the continent in the 18th century, which corresponds to the height of the transatlantic slave trade, possibly explaining the high prevalence of HSV-2 in the Americas (second highest after Africa). The limited geographic clustering of HSV-1 makes it difficult to date its exit from Africa. The split between the basal clade, containing mostly African sequences, and all other strains was dated at ∼5,000 years ago. Our data do not imply that herpes simplex viruses did not infect early humans but show that the worldwide distribution of circulating strains is the result of relatively recent events.

Preventing HIV and HSV-2 through knowledge and attitudes: A replication study of a multi-component community-based intervention in Zimbabwe.

IntroductionApproximately two-thirds of HIV-infected individuals reside in sub-Saharan Africa. The region accounts for 68% of the new HIV infections occurring worldwide with almost one-half of these infections being among young adults aged 12–24 years. Cowan and colleagues conducted a community-based, multi-component HIV intervention aimed at youth in rural Zimbabwe. Despite some changes in knowledge and attitudes, the community-based intervention did not affect the prevalence of HIV or HSV-2. We selected this frequently cited study for replication since it incorporates individual-, community-, and structural- level intervention components that are often considered in global HIV/AIDS prevention programs. Additionally, the intervention could be easily scaled-up, which is especially important in the context of limited resources. Although this study indicated no intervention effects in reducing HIV, the authors acknowledged some key methodological challenges. Our replication analysis provided important insights regarding the impact of these challenges to the interpretation of the results of this study.MethodsOur replication study focused on replicating Cowan’s findings and assessing the robustness of Cowan’s results to alternative analytical models based on their study design. We determined how out-migration occurring during Cowan’s study may have affected the population characteristics, the intervention exposure level, and the study findings. While the original intervention targeted knowledge and attitudes as a mechanism to decrease HIV/HSV-2, the Cowan study evaluated the intervention effects on knowledge, attitudes, and prevalence of HIV or HSV-2 separately. To better identify the pathway describing the interrelationship among the intervention and knowledge, attitudes, and prevalence of HIV or HSV-2, we assessed whether increases in knowledge or attitudes were associated with decreased HIV or HSV-2 prevalence.ResultsWe replicated the original findings with minor discrepancies during the pure replication. Our additional analyses revealed that the study population characteristics changed over time in ways that may have affected outcomes. These changes also affected the levels of intervention exposure, with 48.7% males and 75.5% females of the intervention group receiving low-level exposure. Both genders with higher level intervention exposure experienced higher increments in multiple knowledge, attitude, and sexual risk behavior outcomes. Unfortunately, these did not translate to a significant reduction in HIV or HSV-2 regardless of the level and combination of knowledge and attitude domains. However, males receiving high-level intervention exposure compared to control indicated significantly lower odds of having HIV or HSV-2 under a Bayesian modeling paradigm.ConclusionsOur findings suggest a more robust conclusion on the study intervention effects. Further study based on a design that more consistently maximizes the exposure level of the intervention is necessary and should ideally be an evaluated goal in similar studies. Evaluation of the intervention impact for key subgroups of the target population is important and would better advise the use and scale-up of the evaluated interventions in various contexts. Our observation of a consistent lack of relationship between knowledge/attitudes and HIV/HSV-2 suggests a need to explore and include relevant additional and or complementary interventions, e.g., promoting effective skills in reducing risky sexual behaviors and addressing cultural and structural bottlenecks that may reduce HIV/HSV-2 risk among youth.

2283 Herpes Simplex Virus Hepatitis in Immunocompetent Hosts - A Case Series Demonstrating the Importance of Early Recognition and Empiric Antiviral Therapy

INTRODUCTION: Herpes simplex virus (HSV) is a highly prevalent virus but only rarely results in fulminant hepatitis. The prevalence of HSV1 and HSV2 are reportedly 53.9% and 15.7% in the general United States population. However, despite the high prevalence it is only responsible for 1% of all acute liver failure. Immunocompetent individuals represent only 24% of these cases. We present three cases of HSV hepatitis in the presumed immunocompetent host. CASE DESCRIPTION/METHODS: Case 1: A 70 y.o male with type II diabetes presented with high fevers. His transaminases peaked at AST 973 and ALT 1183. His INR and T Bili both peaked at 1.4. Due to the anicteric nature of his hepatitis, he was started on empiric acyclovir. He developed nonspecific encephalopathy, later attributed to hospital acquired delirium. Cerebrospinal fluid was negative for HSV. His HSV serum PCR was positive for HSV1 on day 8. He later developed painful oropharyngeal ulcers. His liver enzymes and mental status would normalize. Case 2: A 19 y.o female with osteogenesis imperfecta and lupus (treatment naive) presented after a sexual assault with fevers. She developed right upper quadrant pain and a pustular rash on upper extremities. Her liver enzymes peaked at AST 2,480 and ALT 824 on day five of admission. Her INR and total bilirubin peaked at 2.8 and 1.5, respectively. Due to the anicteric nature of her hepatitis, she was empirically treated with acyclovir. Her serum HSV PCR returned positive for HSV2 on day twenty. Liver enzymes improved and she was discharged on PO valganciclovir. Case 3: A 21 y.o female with history of chlamydial infection presented with a diffuse urticarial rash, fever and right upper quadrant pain. Her AST was 2389 and ALT 1896. Total bilirubin peaked at 1.3. Due to the anicteric nature of her hepatitis, she was empirically treated with acyclovir. PCR of an oral lesion was positive for HSV2 and her serum PCR was positive for HSV2. She recovered completely. DISCUSSION: Despite low occurrence rates, our cases demonstrate HSV hepatitis must be kept in the differential diagnosis of hepatitis in the immunocompetent host. Progression to acute liver failure (ALF) occurs in 74% of HSV hepatitis cases. ALF from HSV has a mortality rate of 90%. Therefore, high clinical suspicion must be maintained for favorable outcomes. Fortunately, our patients had resolution of their HSV hepatitis due to early recognition of anicteric hepatitis and treatment with empiric acyclovir.

Modelling the Effects of Early Sexual Debut on the Transmission Dynamics of HSV-2

Early sexual debut has always been associated with sexually transmitted infections. A mathematical model is developed to capture the effects of early sexual debut on HSV-2. The threshold parameters of the model are determined and stabilities are analysed. Analysis of the threshold quantity known as the reproduction number has shown that if the population is dominated by the young individuals, the prevalence of HSV-2 is faster as compared to the one dominated by the adult population. PRCCs and Latin Hypercube Sampling has been used to assess the amount of change inherent in the model as captured by the terms that define the threshold quantity. Furthermore, numerical simulations of the model show that early sexual debut has an effect of increasing HSV-2 prevalence within the general population.