Genital herpes has played a more important role than any other sexually transmitted infection in driving HIV prevalence in Africa.
Genital herpes has played a more important role than any other sexually transmitted infection in driving HIV prevalence in Africa.
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DOI：
10.1371/journal.pone.0002230
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发表时间：
2008-05-21
期刊：
影响因子：
3.7
通讯作者：
Corey L
中科院分区：
文献类型：
--
作者：
Abu-Raddad LJ;Magaret AS;Celum C;Wald A;Longini IM Jr;Self SG;Corey L
来自观察性研究的大量证据表明生殖器疱疹在艾滋病毒流行中的作用。一些疱疹疫苗正在开发中，几项关于阿昔洛韦治疗HSV-2在减少HIV感染、传播和疾病进展方面的疗效的试验刚刚报告了结果，或将在明年报告结果。这些干预措施的潜在影响需要对艾滋病毒和HSV-2在人群水平上的协同作用的程度进行定量评估。构建了HIV和HSV-2动力学和相互作用的确定性房室模型。定性和定量地探讨了流行病学协同作用的性质，并与其他性传播感染（STI）进行了比较。结果表明，HSV-2在撒哈拉以南非洲地区的艾滋病毒传播中比其他性传播感染起着更重要的作用。我们估计，在HSV-2高流行的环境中，如肯尼亚的基苏穆，超过四分之一的HIV感染事件可能直接归因于HSV-2。HSV-2还通过增加人口中艾滋病毒阳性者的数量，大大促进了艾滋病毒的进一步传播，并可能解释四个城市研究中三分之一的艾滋病毒流行率差异。相反，我们估计艾滋病毒对HSV-2流行率的净影响很小。HSV-2作为HIV感染和传播的生物辅助因子，可能对HIV的传播起了很大的作用，特别是通过促进HIV在具有稳定长期性伴侣的低风险人群中的传播。这一发现表明，通过预防性疫苗预防HSV-2感染可能是一种有效的干预措施，无论是在高危人群中HIV发病率高的新生流行病中，还是在大部分HIV传播发生在稳定伙伴关系中的已建立流行病中。
Extensive evidence from observational studies suggests a role for genital herpes in the HIV epidemic. A number of herpes vaccines are under development and several trials of the efficacy of HSV-2 treatment with acyclovir in reducing HIV acquisition, transmission, and disease progression have just reported their results or will report their results in the next year. The potential impact of these interventions requires a quantitative assessment of the magnitude of the synergy between HIV and HSV-2 at the population level. A deterministic compartmental model of HIV and HSV-2 dynamics and interactions was constructed. The nature of the epidemiologic synergy was explored qualitatively and quantitatively and compared to other sexually transmitted infections (STIs). The results suggest a more substantial role for HSV-2 in fueling HIV spread in sub-Saharan Africa than other STIs. We estimate that in settings of high HSV-2 prevalence, such as Kisumu, Kenya, more than a quarter of incident HIV infections may have been attributed directly to HSV-2. HSV-2 has also contributed considerably to the onward transmission of HIV by increasing the pool of HIV positive persons in the population and may explain one-third of the differential HIV prevalence among the cities of the Four City study. Conversely, we estimate that HIV had only a small net impact on HSV-2 prevalence. HSV-2 role as a biological cofactor in HIV acquisition and transmission may have contributed substantially to HIV particularly by facilitating HIV spread among the low-risk population with stable long-term sexual partnerships. This finding suggests that prevention of HSV-2 infection through a prophylactic vaccine may be an effective intervention both in nascent epidemics with high HIV incidence in the high risk groups, and in established epidemics where a large portion of HIV transmission occurs in stable partnerships.
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