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Association between cervical shedding of herpes simplex virus and HIV-1
R Scott McClelland1, Chia C Wang, Julie Overbaugh
1International AIDS Research and Training Program, Department of Medicine, University of Washington, Box 359909, 325 9th Avenue, Seattle, WA 98104, USA. mcclell@u.washington.edu
Objective:
To investigate the association between the cervical shedding of herpes simplex virus (HSV) and HIV-1.
Design:
A cross-sectional study on 200 women seropositive for both HSV-2 and HIV-1 was conducted in a family planning clinic at the Coast Provincial General Hospital, Mombasa, Kenya.
Main Outcome Measures:
Quantities of HSV DNA (types 1 and 2) and HIV-1 RNA as well as the presence or absence of HIV-1 proviral DNA in cervical secretions were determined and compared.
Results:
There was a significant correlation between the quantities of HSV DNA and HIV-1 RNA in the cervical secretions of HSV-shedding women (Pearson's r = 0.24, P = 0.05). A 10-fold increase in the quantity of cervical HSV DNA was associated with 1.35-fold higher cervical HIV-1-RNA levels (95% CI 1.00-1.81; P = 0.05), and with 1.36-fold greater odds of detection of HIV-1 proviral DNA (95% CI 1.05-1.75; P = 0.02).
Conclusion:
Higher levels of cervical HSV were associated with higher levels of expressed HIV-1 and with the more frequent detection of HIV-1-infected cells in cervical secretions. Prospective studies are needed to explore further the association between non-ulcerative cervical HSV reactivation and HIV-1 shedding. Such a relationship may have important implications for interventions designed to slow the spread of HIV-1.