Sexual transmission

Recent infection with genital herpes increases chances of HIV seroconversion

Michael Carter
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Recent infection with genital herpes ulcers substantially increases the chances of seroconverting for HIV, according to a recently issued policy brief from the South African Medical Research Council (MRC).

Herpes simplex virus II (HSV-2) is the most common cause of genital ulcers worldwide and it has long been recognised that by disruption of the epithelial barrier and general inflammation HSV-2 may increase the chances of infection with HIV.

The MRC policy paper is based upon the results of a study involving over 400 female sex workers at truck stops between Durban and Johannesburg. These women were screened for HIV. Only 198 were found to be HIV-negative and they were monitored monthly over three years. Of the women who seroconverted during the study, all but six became HSV-2 positive before they became HIV-positive, suggesting to the investigators that “immediately after infection with HSV-2, the risk of contracting HIV-1 increases significantly.”

Glossary

herpes simplex virus (HSV)

A viral infection which may cause sores around the mouth or genitals.

seroconversion

The transition period from infection with HIV to the detectable presence of HIV antibodies in the blood. When seroconversion occurs (usually within a few weeks of infection), the result of an HIV antibody test changes from HIV negative to HIV positive. Seroconversion may be accompanied with flu-like symptoms.

 

genital ulcer disease

Any of several diseases that are characterised by genital sores, blisters or lesions. Genital ulcer diseases (including genital herpes, syphilis and chancroid) are usually sexually transmitted.

inflammation

The general term for the body’s response to injury, including injury by an infection. The acute phase (with fever, swollen glands, sore throat, headaches, etc.) is a sign that the immune system has been triggered by a signal announcing the infection. But chronic (or persisting) inflammation, even at low grade, is problematic, as it is associated in the long term to many conditions such as heart disease or cancer. The best treatment of HIV-inflammation is antiretroviral therapy.

lesions

Small scrapes, sores or tears in tissue. Lesions in the vagina or rectum can be cellular entry points for HIV.

However, investigators also found that women who were already HSV-2-positive at the start of the study had a lower risk of HIV seroconversion than those who were HSV-2-negative at the start of the study. The investigators speculate that the women already infected with HSV-2 were protected from reinfection with HSV-2, thus reducing the chance of acquiring HSV-2 ulcerative lesions which are a risk factor for HIV. The finding also lends support to the view that the two events of HSV-2 and HIV seroconversion are closely linked in time.

The South African MRC concludes that the study findings have “enormous public health implications in South Africa and the developing world where infection with HIV-1 and HSV-2 coexist” and make the following recommendations:

 

 

 

 

 

 

 

 

 

  • There is an urgent need to recognise HSV-2 infection amongst populations at risk, especially amongst the young, and to provide treatment and counselling on condom use.
  • Identification of HSV-2 infection in pregnancy may indirectly impact on mother-to-baby transmission of HIV-1.
  • Priority should be given to the development of rapid tests for HSV-2.
  • HIV and HSV-2 prevention efforts should be integrated.
  • There is an urgent need to develop an HSV-2 vaccine which would curb both the spread of HSV-2 and HIV.

 

References

Ramjee G et al. Herpes simplex virus type II infection is a risk factor for HIV seroconversion. South African MRC policy brief 3, August 2002.

Related topics
Sexual transmission
Sexually transmitted infections epidemiology
The biology of HIV transmission
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