No association between herpes simplex virus type-2 seropositivity or anogenital lesions and HIV seroconversion among homosexual men.

Recent reports have suggested that HSV-2 infection and associated anogenital ulcerations represent an important risk factor for acquisition of HIV infection. Although this is an appealing biological hypothesis, inferences drawn for homosexual men, as well as other at-risk populations, must be made after careful consideration of methods to control for potential confounding data. This report utilized a nested case-control study in which 49 homosexual HIV seroconverters were compared to 49 homosexual seronegative men matched on the prior level of receptive anal intercourse. No differences were observed for prior HSV-2 infection, since 21/49 (43%) of matched HIV seronegative men were HSV-2 antibody positive and 21/49 (43%) of HIV seroconverters were HSV-2 antibody positive at the visit 6 months before HIV seroconversion (odds ratio of 1.0, 95% confidence limits of 0.3-2.9) Similar findings were also observed for prior HSV-1 infection. Both self-reported symptoms and physical exam findings suggestive of HSV infection were rare during the 12 months prior to seroconversion and not associated with HIV seroconversion. These data do not support HSV-2 as a risk factor for seroconversion to HIV among homosexual men studied. These results should not be generalized to heterosexual transmission of HIV, particularly in Africa, where both an increased prevalence of genital ulcerative diseases and different etiologies have been observed.