孕产妇2型单纯疱疹病毒合并感染增加围产期HIV传播风险：是否有可能进一步降低传播率？

Maternal herpes simplex virus type 2 coinfection increases the risk of perinatal HIV transmission: possibility to further decrease transmission?

作者信息

Bollen Liesbeth Jm, Whitehead Sara J, Mock Philip A, Leelawiwat Wanna, Asavapiriyanont Suvanna, Chalermchockchareonkit Amphan, Vanprapar Nirun, Chotpitayasunondh Tawee, McNicholl Janet M, Tappero Jordan W, Shaffer Nathan, Chuachoowong Rutt

机构信息

Thailand Ministry of Public Health, US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.

出版信息

AIDS. 2008 Jun 19;22(10):1169-76. doi: 10.1097/QAD.0b013e3282fec42a.

DOI:10.1097/QAD.0b013e3282fec42a

PMID:18525263

Abstract

OBJECTIVES

To evaluate the association between maternal herpes simplex virus type 2 seropositivity and genital herpes simplex virus type 2 shedding with perinatal HIV transmission.

STUDY DESIGN

Evaluation of women who participated in a 1996-1997 perinatal HIV transmission prevention trial in Thailand.

METHODS

In this nonbreastfeeding population, women were randomized to zidovudine or placebo from 36 weeks gestation through delivery; maternal plasma and cervicovaginal HIV viral load and infant HIV status were determined for the original study. Stored maternal plasma and cervicovaginal samples were tested for herpes simplex virus type 2 antibodies by enzyme-linked immunoassay and for herpes simplex virus type 2 DNA by real-time PCR, respectively.

RESULTS

Among 307 HIV-positive women with available samples, 228 (74.3%) were herpes simplex virus type 2 seropositive and 24 (7.8%) were shedding herpes simplex virus type 2. Herpes simplex virus type 2 seropositivity was associated with overall perinatal HIV transmission [adjusted odds ratio, 2.6; 95% confidence interval, 1.0-6.7)], and herpes simplex virus type 2 shedding was associated with intrapartum transmission (adjusted odds ratio, 2.9; 95% confidence interval, 1.0-8.5) independent of plasma and cervicovaginal HIV viral load, and zidovudine treatment. Median plasma HIV viral load was higher among herpes simplex virus type 2 shedders (4.2 vs. 4.1 log(10)copies/ml; P = 0.05), and more shedders had quantifiable levels of HIV in cervicovaginal samples, compared with women not shedding herpes simplex virus type 2 (62.5 vs. 34.3%; P = 0.005).

CONCLUSION

We found an increased risk of perinatal HIV transmission among herpes simplex virus type 2 seropositive women and an increased risk of intrapartum HIV transmission among women shedding herpes simplex virus type 2. These novel findings suggest that interventions to control herpes simplex virus type 2 infection could further reduce perinatal HIV transmission.

摘要

目的

评估孕产妇2型单纯疱疹病毒血清学阳性及2型单纯疱疹病毒生殖器排毒与围产期HIV传播之间的关联。

研究设计

对参与1996 - 1997年泰国围产期HIV传播预防试验的女性进行评估。

方法

在这个非母乳喂养人群中，女性从妊娠36周直至分娩被随机分为接受齐多夫定或安慰剂治疗；原始研究测定了孕产妇血浆和宫颈阴道HIV病毒载量以及婴儿的HIV感染状况。分别采用酶联免疫吸附测定法检测储存的孕产妇血浆和宫颈阴道样本中的2型单纯疱疹病毒抗体，采用实时PCR检测2型单纯疱疹病毒DNA。

结果

在307名有可用样本的HIV阳性女性中，228名（74.3%）为2型单纯疱疹病毒血清学阳性，24名（7.8%）正在排出2型单纯疱疹病毒。2型单纯疱疹病毒血清学阳性与总体围产期HIV传播相关[校正比值比为2.6；95%置信区间为1.0 - 6.7]，2型单纯疱疹病毒排毒与产时传播相关（校正比值比为2.9；95%置信区间为1.0 - 8.5），且独立于血浆和宫颈阴道HIV病毒载量以及齐多夫定治疗。2型单纯疱疹病毒排毒者的血浆HIV病毒载量中位数更高（4.2对4.1 log₁₀拷贝/毫升；P = 0.05），与未排出2型单纯疱疹病毒的女性相比，更多排毒者的宫颈阴道样本中有可检测到的HIV水平（62.5%对34.3%；P = 0.005）。