Department of Medicine, University of Washington, Seattle, Washington, United States of America.
PLoS One. 2011;6(5):e19947. doi: 10.1371/journal.pone.0019947. Epub 2011 May 26.
Co-infection with herpes simplex virus type 2 (HSV-2) has been associated with increased HIV-1 RNA levels and immune activation, two predictors of HIV-1 progression. The impact of HSV-2 on clinical outcomes among HIV-1 infected pregnant women is unclear.
HIV-1 infected pregnant women in Nairobi were enrolled antenatally and HSV-2 serology was obtained. HIV-1 RNA and CD4 count were serially measured for 12-24 months postpartum. Survival analysis using endpoints of death, opportunistic infection (OI), and CD4<200 cells µL, and linear mixed models estimating rate of change of HIV-1 RNA and CD4, were used to determine associations between HSV-2 serostatus and HIV-1 progression.
Among 296 women, 254 (86%) were HSV-2-seropositive. Only 30 (10%) women had prior or current genital ulcer disease (GUD); median baseline CD4 count was 422 cells µL. Adjusting for baseline CD4, women with GUD were significantly more likely to have incident OIs (adjusted hazard ratio (aHR) 2.79, 95% CI: 1.33-5.85), and there was a trend for association between HSV-2-seropositivity and incident OIs (aHR 3.83, 95% CI: 0.93-15.83). Rate of change in CD4 count and HIV-1 RNA did not differ by HSV-2 status or GUD, despite a trend toward higher baseline HIV-1 RNA in HSV-2-seropositive women (4.73 log10 copies/ml vs. 4.47 log10 copies/ml, P = 0.07).
HSV-2 was highly prevalent and pregnant HIV-1 infected women with GUD were significantly more likely to have incident OIs than women without GUD, suggesting that clinically evident HSV-2 is a more important predictor of HIV-1 disease progression than asymptomatic HSV-2.
单纯疱疹病毒 2 型（HSV-2）合并感染与 HIV-1 RNA 水平升高和免疫激活有关，这两者都是 HIV-1 进展的预测因素。HSV-2 对感染 HIV-1 的孕妇临床结局的影响尚不清楚。
在内罗毕，对感染 HIV-1 的孕妇进行了产前登记，并获得了 HSV-2 血清学检查结果。产后 12-24 个月内连续测量 HIV-1 RNA 和 CD4 计数。使用终点为死亡、机会性感染（OI）和 CD4<200 个细胞/μL 的生存分析，以及估计 HIV-1 RNA 和 CD4 变化率的线性混合模型，来确定 HSV-2 血清学状态与 HIV-1 进展之间的关联。
在 296 名女性中，254 名（86%）为 HSV-2 血清阳性。只有 30 名（10%）女性有生殖器溃疡疾病（GUD）的既往或现症；中位基线 CD4 计数为 422 个细胞/μL。调整基线 CD4 后，GUD 女性发生 OI 的可能性显著更高（调整后的危险比[aHR]为 2.79，95%CI：1.33-5.85），且 HSV-2 血清阳性与 OI 发生之间存在趋势关联（aHR 为 3.83，95%CI：0.93-15.83）。尽管 HSV-2 血清阳性的女性基线 HIV-1 RNA 水平有升高趋势（4.73 log10 拷贝/ml 比 4.47 log10 拷贝/ml，P=0.07），但 CD4 计数和 HIV-1 RNA 的变化率在 HSV-2 状态或 GUD 方面并无差异。
HSV-2 高度流行，患有 GUD 的感染 HIV-1 的孕妇发生 OI 的可能性显著高于没有 GUD 的孕妇，这表明临床上明显的 HSV-2 是 HIV-1 疾病进展的更重要预测因素，而非无症状 HSV-2。
