Impact of herpes simplex virus type 2 on HIV-1 acquisition and progression in an HIV vaccine trial (the Step study).
Impact of herpes simplex virus type 2 on HIV-1 acquisition and progression in an HIV vaccine trial (the Step study).
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DOI：
10.1097/qai.0b013e31821acb5
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发表时间：
2011-07-01
期刊：
影响因子：
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通讯作者：
NIAID HIV Vaccine Trials Network
中科院分区：
文献类型：
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作者：
Barnabas RV;Wasserheit JN;Huang Y;Janes H;Morrow R;Fuchs J;Mark KE;Casapia M;Mehrotra DV;Buchbinder SP;Corey L;NIAID HIV Vaccine Trials Network
大量的观察数据表明，HSV-2感染可能促进HIV感染，增加HIV病毒载量，加速HIV进展和向前传播。为了探索这些关系，我们在一项国际HIV疫苗试验中研究了预先存在的HSV-2感染的影响。我们分析了1836名男男性行为者（MSM）中流行的HSV-2感染与HIV-1获得和进展之间的关系。我们使用考克斯比例风险回归模型来估计HSV-2感染与HIV获得和ART启动之间的关联，并使用线性回归来探索HSV-2对ART前病毒载量的影响。在所有志愿者中，HSV-2感染增加了HIV-1感染的风险（调整后的风险比为2.2; 95% CI，1.4 - 3.5）。调整人口统计学变量、包皮环切术、Ad 5滴度和重大风险行为后，HSV-2感染安慰剂接受者的HIV感染风险是HSV-2血清阴性者的3倍（风险比3.3; 95%CI，1.6 - 6.9）。既往HSV-2感染与0.2 log 10拷贝/ml较高的调整平均设定点病毒载量相关（95% CI，0.3低至0.6高）。HSV-2感染与ART开始时间无关。在HIV-1疫苗试验的MSM中，预先存在的HSV-2感染是HIV感染的主要风险因素。过去的HSV-2并没有显着增加HIV病毒载量或早期疾病进展。HSV-2血清反应阳性的人可能比HSV-2血清反应阴性的人更难使用疫苗或其他预防策略来保护免受HIV感染。
Extensive observational data suggest that HSV-2 infection may facilitate HIV acquisition, increase HIV viral load, and accelerate HIV progression and onward transmission. To explore these relationships, we examined the impact of pre-existing HSV-2 infection in an international HIV vaccine trial. We analyzed the associations between prevalent HSV-2 infection and HIV-1 acquisition and progression among 1836 men who have sex with men (MSM). We used Cox proportional hazards regression models to estimate the association between HSV-2 infection and both HIV acquisition and ART initiation, and linear regression to explore the effect of HSV-2 on pre-ART viral load. HSV-2 infection increased risk of HIV-1 acquisition among all volunteers (adjusted hazard ratio 2.2; 95% CI, 1.4 to 3.5). Adjusting for demographic variables, circumcision, Ad5 titer and significant risk behaviors, the risk of HIV acquisition among HSV-2 infected placebo recipients was three fold higher than HSV-2 seronegatives (hazard ratio 3.3; 95% CI, 1.6 to 6.9). Past HSV-2 infection was associated with a 0.2 log10 copies/ml higher adjusted mean set point viral load (95% CI, 0.3 lower to 0.6 higher). HSV-2 infection was not associated with time to ART initiation. Among MSM in an HIV-1 vaccine trial, pre-existing HSV-2 infection was a major risk factor for HIV acquisition. Past HSV-2 did not significantly increase HIV viral load or early disease progression. HSV-2 seropositive persons will likely prove more difficult than HSV-2 seronegative persons to protect against HIV infection using vaccines or other prevention strategies.