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HSV-2 shedding common among Africans regardless of HIV infection
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Herpes simplex virus type 2 genital shedding appeared prevalent in Ugandan adults with the infection regardless of HIV status, according to a recently published study.
“Several lines of evidence suggest that [herpes simplex virus type 2 (HSV-2)] infection in Africa may differ from that in the United States,” the researchers wrote. “Because populations in [sub-Saharan Africa] have the highest prevalence of HSV-2 infection and are most likely to benefit from novel interventional and prevention trials, including studies of candidate HSV-2 vaccines, there is a need to assess viral shedding in carefully characterized cohorts in this region.”
Researchers examined shedding among men and women with HSV-2 residing in Kampala, Uganda. Participants were referred by clinicians between June 2011 and January 2012, with those coinfected with HIV eligible if they were not currently receiving ART. After being trained by a clinician, participants self-collected swab specimens three times daily for 42 days. Specimens were tested for HSV-2 antibodies using the Focus HerpeSelect enzyme-linked immunosorbent assay, and subsequently confirmed by HSV Western blotting. Disease symptoms and patient examinations were conducted during weekly clinic visits.
Ninety-three participants (median age, 36 years; 67% women; 58% with HIV) were enrolled in the study, resulting in 11,283 genital swabs collected over 3,869 days.
Shedding was detected in 22% of collected specimens, was seen at least once among 94% of participants. Genital lesions were reported on 19% of study days, and subclinical shedding was detected among 16% of specimens collected on days without lesions. Male sex and history of genital herpes symptoms were associated with more frequent genital lesions.
Compared with women, men had higher rates of total shedding (RR = 2; 95% CI, 1.3-2.9) as well as subclinical shedding (RR = 1.7; 95% CI, 1.1-2.7). Among participants with HIV, low CD4+ T-cell counts and high plasma RNA load were associated with increased shedding; however, HIV infection itself was not associated with increased shedding.
“These findings underscore the need for broad-based implementation of traditional genital herpes management strategies in [sub-Saharan Africa], including long-term antiviral medications and consistent condom use,” the researchers wrote. “Our study also highlights the potential benefits of novel prevention interventions, including an HSV-2 vaccine, which would not only reduce the morbidity and mortality related to HSV-2 infection but could also help curtail the HIV epidemic in [sub-Saharan Africa].” – by Dave Muoio
Disclosure: Phipps reports no relevant financial disclosures. Please see the full study for a list of all other relevant financial disclosures.
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