Herpes simplex virus type 2 and risk of intrapartum human immunodeficiency virus transmission. Obstet Gynecol . 2007 Feb; 109 ( 2 Pt 1 ): 403-9 . Erratum in: Obstet Gynecol. 2007 Apr;109(4):1002-3. PMID: 17267842 [PubMed - indexed for MEDLINE] Drake AL, J

Citation:
C. DRWAMALWADALTON, MBORI- PROFNGACHADOROTHYA. "Herpes simplex virus type 2 and risk of intrapartum human immunodeficiency virus transmission. Obstet Gynecol . 2007 Feb; 109 ( 2 Pt 1 ): 403-9 . Erratum in: Obstet Gynecol. 2007 Apr;109(4):1002-3. PMID: 17267842 [PubMed - indexed for MEDLINE] Drake AL, J.". In: Obstet Gynecol . 2007 Feb; 109 ( 2 Pt 1 ): 403-9 . Erratum in: Obstet Gynecol. 2007 Apr;109(4):1002-3. Earthscan, London. 978-1-84407-469-3 (*); 2007.

Abstract:

Departments of Epidemiology and Medicine, University of Washington, Seattle, WA 98195, USA. adrake2@u.washington.edu
OBJECTIVE: To determine whether herpes simplex virus type 2 (HSV-2) infection was associated with risk of intrapartum human immunodeficiency virus type 1 (HIV-1) transmission and to define correlates of HSV-2 infection among HIV-1-seropositive pregnant women. METHODS: We performed a nested case control study within a perinatal cohort in Nairobi, Kenya. Herpes simplex virus type 2 serostatus and the presence of genital ulcers were ascertained at 32 weeks of gestation. Maternal cervical and plasma HIV-1 RNA and cervical HSV DNA were measured at delivery. RESULTS: One hundred fifty-two (87%) of 175 HIV-1-infected mothers were HSV-2-seropositive. Among the 152 HSV-2-seropositive women, nine (6%) had genital ulcers at 32 weeks of gestation, and 13 (9%) were shedding HSV in cervical secretions. Genital ulcers were associated with increased plasma HIV-1 RNA levels (P=.02) and an increased risk of intrapartum HIV-1 transmission (16% of transmitters versus 3% of nontransmitters had ulcers; P = .003), an association which was maintained in multivariable analysis adjusting for plasma HIV-1 RNA levels (P=.04). We found a borderline association for higher plasma HIV-1 RNA among women shedding HSV (P=.07) and no association between cervical HSV shedding and either cervical HIV-1 RNA levels or intrapartum HIV-1 transmission (P=.4 and P=.5, [corrected] respectively). CONCLUSION: Herpes simplex virus type 2 is the leading cause of genital ulcers among women in sub-Saharan Africa and was highly prevalent in this cohort of pregnant women receiving prophylactic zidovudine. After adjusting for plasma HIV-1 RNA levels, genital ulcers were associated with increased risk of intrapartum HIV-1 transmission. These data suggest that management of HSV-2 during pregnancy may enhance mother-to-child HIV-1 prevention efforts. LEVEL OF EVIDENCE: II.
PMID: 17267842 [PubMed - indexed for MEDLINE]

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