TY - JOUR
T1 - Sexually transmitted bedfellows
T2 - Exquisite association between HIV and herpes simplex virus type 2 in 21 communities in Southern Africa in the HIV prevention trials network 071 (PopART) Study
AU - on behalf of the HPTN 071 (PopART) Study Team
AU - Bradley, John
AU - Floyd, Sian
AU - Piwowar-Manning, Estelle
AU - Laeyendecker, Oliver
AU - Young, Alicia
AU - Bell-Mandla, Nomtha
AU - Bwalya, Justin
AU - Bock, Peter
AU - Fidler, Sarah
AU - Ayles, Helen
AU - Hayes, Richard J.
N1 - Funding Information:
Financial support. This work was supported by the National Institute of Allergy and Infectious Diseases (cooperative agreements UM1-AI068619, UM1-AI068617, and UM1-AI068613HPTN 071), the US President’s Emergency Plan for AIDS Relief, the International Initiative for Impact Evaluation, the Bill and Melinda Gates Foundation, the National Institute on Drug Abuse, and the National Institute of Mental Health.
Publisher Copyright:
© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America.
PY - 2018/7/2
Y1 - 2018/7/2
N2 - Background Human immunodeficiency virus (HIV) and herpes simplex virus type 2 (HSV2) are strongly associated, although mechanisms are not fully understood. An HIV prevention trial allowed reexamination of this association at individual and community levels. Methods The HIV Prevention Trials Network 071 (PopART) study evaluates a combination prevention intervention in 21 urban communities in Zambia and South Africa. To measure impact on HIV infection incidence, a cohort of approximately 2000 adults (age range, 18-44 years) was selected randomly from each community. Baseline data on sociodemographic characteristics, behavior, and HIV/HSV2 serologic findings were used to examine the association between HIV and HSV2. At the community level, HIV prevalence was plotted against HSV2 prevalence. Results A total of 38691 adults participated. HSV2 prevalence among women and men was 50% and 22%, respectively, in Zambia and 60% and 27%, respectively, in South Africa. Estimated HSV2 infection incidence among those aged 18-24 years was 8.06 cases/100 person-years (95% confidence interval [CI], 6.76-9.35) and 1.76 cases/100 person-years (95% CI, 1.30-2.22) among women and men, respectively. A 6-fold higher odds of HIV infection was seen in HSV2-infected individuals in both sexes, after adjustment for confounders (odds ratio, 6.66 [95% CI, 6.07-7.31] among women and 6.57 [95% CI, 5.56-7.77] among men). At the community-level, there was a strong linear relationship between HIV and HSV2 prevalence (I= 0.92; P <.001). Conclusions There was an exquisite association between these 2 infections, at the individual and community levels, likely due in part to a powerful cofactor effect of HSV2 on HIV transmission. HSV2 control could contribute to HIV prevention.
AB - Background Human immunodeficiency virus (HIV) and herpes simplex virus type 2 (HSV2) are strongly associated, although mechanisms are not fully understood. An HIV prevention trial allowed reexamination of this association at individual and community levels. Methods The HIV Prevention Trials Network 071 (PopART) study evaluates a combination prevention intervention in 21 urban communities in Zambia and South Africa. To measure impact on HIV infection incidence, a cohort of approximately 2000 adults (age range, 18-44 years) was selected randomly from each community. Baseline data on sociodemographic characteristics, behavior, and HIV/HSV2 serologic findings were used to examine the association between HIV and HSV2. At the community level, HIV prevalence was plotted against HSV2 prevalence. Results A total of 38691 adults participated. HSV2 prevalence among women and men was 50% and 22%, respectively, in Zambia and 60% and 27%, respectively, in South Africa. Estimated HSV2 infection incidence among those aged 18-24 years was 8.06 cases/100 person-years (95% confidence interval [CI], 6.76-9.35) and 1.76 cases/100 person-years (95% CI, 1.30-2.22) among women and men, respectively. A 6-fold higher odds of HIV infection was seen in HSV2-infected individuals in both sexes, after adjustment for confounders (odds ratio, 6.66 [95% CI, 6.07-7.31] among women and 6.57 [95% CI, 5.56-7.77] among men). At the community-level, there was a strong linear relationship between HIV and HSV2 prevalence (I= 0.92; P <.001). Conclusions There was an exquisite association between these 2 infections, at the individual and community levels, likely due in part to a powerful cofactor effect of HSV2 on HIV transmission. HSV2 control could contribute to HIV prevention.
KW - HIV
KW - HSV2
KW - South Africa
KW - Zambia
KW - cofactor
KW - ecological analysis
KW - urban
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U2 - 10.1093/infdis/jiy178
DO - 10.1093/infdis/jiy178
M3 - Article
C2 - 29659909
AN - SCOPUS:85050797193
SN - 0022-1899
VL - 218
SP - 443
EP - 452
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
IS - 3
ER -