Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
Int J STD AIDS. 2024 Jan;35(1):58-66. doi: 10.1177/09564624231201189. Epub 2023 Sep 26.
For women living with HIV (WLHIV), co-infection with herpes simplex virus type 2 (HSV-2) causes severe genital ulcers and presents additional challenges for their HIV care. To inform preventive strategies, we aimed to determine the incidence and risk factors of HSV-2 positivity in a prospective cohort of South African women.
The CAPRISA 002 study enrolled women at acute HIV infection between 2004 and 2020. HSV-2 testing was conducted by multiplex polymerase chain reaction (PCR) assay on collected vaginal swabs up to twice annually during follow-up. We calculated incidence as the number of new cases per 100 person-years (PYs) and used Cox-proportional-hazard regression to identify factors associated with time-to-HSV-2 PCR positivity.
At enrolment, the median age of 171 women was 24 years, interquartile range (IQR 21-28), and the estimated median days since HIV infection was 42 (IQR 22-65). Of participants tested at enrolment, HSV-2 antibody prevalence was 81.4% (105/129), and 10.6% (12/113) were positive by PCR. Among 147 women with a prior negative HSV-2 PCR diagnosis, we observed 47 new HSV-2 PCR positive cases over 424.4 PYs of follow-up, yielding an incidence rate of 11.1 cases per-100-PYs. HSV-2 PCR positivity incidence was higher among younger women (<25 years: adjusted Hazard Ratio [aHR] = 5.91, 95%CI 3.02-11.6), those with bacterial vaginosis (BV) (Nugent score 7-10: aHR = 2.17, 95%CI 1.15-4.10) and lower CD4 counts (<500 cells/μl: aHR = 2.04, 95%CI 1.08-3.87).
After acute HIV infection in women, the incidence of HSV-2 PCR positivity was associated with younger age, BV diagnosis and lower CD4 count.
对于感染人类免疫缺陷病毒（HIV）的女性（WLHIV）来说，单纯疱疹病毒 2 型（HSV-2）的合并感染会导致严重的生殖器溃疡，并给 HIV 护理带来额外的挑战。为了提供预防策略，我们旨在确定南非女性前瞻性队列中 HSV-2 阳性的发生率和危险因素。
CAPRISA 002 研究在 2004 年至 2020 年间招募了急性 HIV 感染的女性。在随访期间，通过多重聚合酶链反应（PCR）检测对采集的阴道拭子进行 HSV-2 检测，每年最多进行两次。我们将发病率定义为每 100 人年（PYs）的新病例数，并使用 Cox 比例风险回归分析来确定与 HSV-2 PCR 阳性时间相关的因素。
在入组时，171 名女性的中位年龄为 24 岁（四分位距[IQR] 21-28），估计 HIV 感染后的中位天数为 42 天（IQR 22-65）。在入组时接受检测的参与者中，HSV-2 抗体流行率为 81.4%（105/129），10.6%（12/113）通过 PCR 检测为阳性。在 147 名先前 HSV-2 PCR 阴性诊断的女性中，我们在 424.4 PY 的随访中观察到 47 例新的 HSV-2 PCR 阳性病例，发病率为每 100-PY 11.1 例。年轻女性（<25 岁：调整后的危险比[aHR] = 5.91，95%CI 3.02-11.6）、细菌性阴道病（BV）（Nugent 评分 7-10：aHR = 2.17，95%CI 1.15-4.10）和较低的 CD4 计数（<500 个细胞/μl：aHR = 2.04，95%CI 1.08-3.87）与 HSV-2 PCR 阳性的发生率更高。
在女性急性 HIV 感染后，HSV-2 PCR 阳性的发生率与年龄较小、BV 诊断和较低的 CD4 计数有关。
