Mayaud P, Nagot N, Konaté I, Ouedraogo A, Weiss H A, Foulongne V, Defer M-C, Sawadogo A, Segondy M, Van de Perre P
Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E7HT, UK.
Sex Transm Infect. 2008 Oct;84(5):332-7. doi: 10.1136/sti.2008.030692. Epub 2008 Jul 2.
To document the natural history of herpes simplex virus type 2 (HSV-2) in relation to HIV and highly active antiretroviral therapy (HAART) in Africa, a longitudinal study was conducted of women in the placebo arms of two randomised controlled trials of HSV-suppressive therapy in Burkina Faso.
22 HIV-uninfected women (group 1), 30 HIV-1-infected women taking HAART (group 2), and 68 HIV-1-infected women not eligible for HAART (group 3) were followed over 24 weeks. HSV-2 DNA was detected on alternate weeks using real-time PCR from cervicovaginal lavages. Plasma HIV-1 RNA was measured every month. CD4 cell counts were measured at enrollment.
Ulcers occurred on 1.9%, 3.1% and 7.2% of visits in groups 1, 2 and 3 (p = 0.02). Cervicovaginal HSV-2 DNA was detected in 45.5%, 63.3% and 67.6% of women (p = 0.11), and on 4.3%, 9.7% and 15.5% of visits in the three groups (p<0.001). Among HIV-infected women, cervicovaginal HSV-2 DNA was detected more frequently during ulcer episodes (adjusted risk ratio (aRR) 2.79, 95% CI 2.01 to 3.86) and less frequently among women practising vaginal douching (aRR 0.60, 95% CI 0.40 to 0.91). Compared with women not taking HAART and with CD4 cell counts of 500 cells/microl or greater, women on HAART had a similar risk of HSV-2 shedding (aRR 0.95, 95% CI 0.52 to 1.73), whereas women with CD4 cell counts of 200-500 cells/microl were more likely to shed HSV-2 (aRR 1.71, 95% CI 1.02 to 2.86).
HSV-2 reactivations occur more frequently among HIV-infected women, particularly those with low CD4 cell counts, and are only partly reduced by HAART. HSV therapy may benefit HIV-infected individuals during HAART.
为记录非洲地区2型单纯疱疹病毒（HSV-2）与HIV及高效抗逆转录病毒治疗（HAART）相关的自然史，在布基纳法索两项HSV抑制疗法随机对照试验的安慰剂组女性中开展了一项纵向研究。
对22名未感染HIV的女性（第1组）、30名接受HAART的HIV-1感染女性（第2组）和68名不符合HAART条件的HIV-1感染女性（第3组）进行了24周的随访。每隔一周使用实时PCR从宫颈阴道灌洗液中检测HSV-2 DNA。每月测量血浆HIV-1 RNA。在入组时测量CD4细胞计数。
第1、2和3组分别有1.9%、3.1%和7.2%的访视出现溃疡（p = 0.02）。45.5%、63.3%和67.6%的女性检测到宫颈阴道HSV-2 DNA（p = 0.11），三组中分别有4.3%、9.7%和15.5%的访视检测到（p<0.001）。在HIV感染女性中，溃疡发作期间宫颈阴道HSV-2 DNA检测更为频繁（调整风险比（aRR）2.79，95%置信区间2.01至3.86），而在进行阴道灌洗的女性中检测频率较低（aRR 0.60，95%置信区间0.40至0.91）。与未接受HAART且CD4细胞计数为500个/微升或更高的女性相比，接受HAART的女性HSV-2脱落风险相似（aRR 0.95，95%置信区间0.52至1.73），而CD4细胞计数为200 - 500个/微升的女性更有可能脱落HSV-2（aRR 1.71，95%置信区间1.02至2.86）。
HSV-2再激活在HIV感染女性中更频繁发生，尤其是CD4细胞计数低的女性，且HAART仅部分降低了这种情况。HSV治疗可能使接受HAART的HIV感染个体受益。
