Sobngwi-Tambekou Joelle, Taljaard Dirk, Lissouba Pascale, Zarca Kevin, Puren Adrian, Lagarde Emmanuel, Auvert Bertram
INSERM U687, Villejuif, France.
J Infect Dis. 2009 Apr 1;199(7):958-64. doi: 10.1086/597208.
The objectives of this study were to assess the impact among young men of herpes simplex virus type 2 (HSV-2) status on the acquisition of human immunodeficiency virus (HIV) and on the protective effect of male circumcision against HIV acquisition.
We used data collected during a male circumcision trial conducted in Orange Farm, South Africa. We estimated adjusted incidence rate ratios (IRRs) for HIV acquisition, using survival analysis and background characteristics, HSV-2 status, male circumcision status, and sexual behavior as covariates.
Compared with subjects who remained HSV-2 negative throughout the study, subjects who were HSV-2 positive at enrollment had an adjusted IRR of 3.3 (95% confidence interval [CI], 1.5-7.4; P=.004), and those who became HSV-2 positive during follow-up had an adjusted IRR of 7.0 (95% CI, 3.9-12.4; P<.001). The population fraction of incident HIV infection attributable to HSV-2 was 27.8% (95% CI, 17.7%-37.2%). Intention-to-treat analysis of the protective effect of male circumcision on HIV acquisition was the same among men with and men without HSV-2 (0.38 vs. 0.37; P=.93).
This study shows that HSV-2 has a substantial impact on HIV acquisition among young South African men. It suggests that HSV-2 infection enhances HIV acquisition and is responsible for approximately 25% of incident cases of HIV infection. However, the protective effect of male circumcision against HIV acquisition appears independent of HSV-2 serostatus.
ClinicalTrials.gov identifier: NCT00122525.
本研究的目的是评估2型单纯疱疹病毒（HSV-2）感染状况对年轻男性感染人类免疫缺陷病毒（HIV）的影响，以及男性包皮环切术对预防HIV感染的保护作用。
我们使用了在南非奥兰治农场进行的一项男性包皮环切术试验期间收集的数据。我们采用生存分析方法，并将背景特征、HSV-2感染状况、男性包皮环切术状况和性行为作为协变量，估计HIV感染的调整发病率比（IRR）。
与在整个研究过程中始终保持HSV-2阴性的受试者相比，入组时HSV-2阳性的受试者调整后的IRR为3.3（95%置信区间[CI]，1.5-7.4；P=0.004），随访期间变为HSV-2阳性的受试者调整后的IRR为7.0（95%CI，3.9-12.4；P<0.001）。HSV-2导致的HIV感染新发病例的人群归因分数为27.8%（95%CI，17.7%-37.2%）。在有HSV-2感染和无HSV-2感染的男性中，男性包皮环切术对预防HIV感染的意向性分析结果相同（0.38对0.37；P=0.93）。
本研究表明，HSV-2对南非年轻男性感染HIV有重大影响。这表明HSV-2感染会增加HIV感染风险，约25%的HIV感染新发病例与之有关。然而，男性包皮环切术对预防HIV感染的保护作用似乎与HSV-2血清学状态无关。
ClinicalTrials.gov标识符：NCT00122525。
