Global and regional estimates of the contribution of herpes simplex virus type 2 infection to HIV incidence: a population attributable fraction analysis using published epidemiological data
Global and regional estimates of the contribution of herpes simplex virus type 2 infection to HIV incidence: a population attributable fraction analysis using published epidemiological data
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DOI：
10.1016/s1473-3099(19)30470-0
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发表时间：
2020-02-01
影响因子：
56.3
通讯作者：
Gottlieb, Sami L.
中科院分区：
文献类型：
--
作者：
Looker, Katharine J.;Welton, Nicky J.;Gottlieb, Sami L.
2017年对55项前瞻性研究进行的系统综述和荟萃分析发现，在单纯疱疹病毒2型（HSV-2）感染的个体中，HIV感染的调整风险至少增加了两倍。我们的目的是评估HSV-2感染对HIV发病率的潜在贡献，考虑HSV-2对HIV获得的影响。（世卫组织区域）按年龄分列的可归因于HSV-2感染的人群比例和艾滋病毒感染事件数（15-24岁、25-49岁和15-49岁）、性别和HSV-2感染的时间（已确诊vs近期获得）。通过将HSV-2和HIV感染数据与来自系统性综述和荟萃分析的HSV-2感染对HIV感染影响的合并相对风险（RR）估计值合并计算估计值。由于HSV-2和HIV有共同的性和其他危险因素，除了HSV相关的生物学因素会增加HIV风险外，我们只使用了调整了潜在混杂因素的RR估计值。（95%不确定性区间317000 - 546000; PAF 29.6% [22.9-37.1]）2016年15-49岁人群中的140万例性获得性事件HIV感染可归因于HSV-2感染。在世卫组织非洲区域，HSV-2对艾滋病毒的贡献最大（巴基斯坦妇女基金37.1% [28.7-46.3]），妇女（34.8% [23.5-45.0]），25-49岁的个人（32.4% [25.4-40.2]），并确定HSV-2感染（26.8% [19.7-34.5]）。解释HIV的大量负担可能归因于HSV-2感染，即使HSV-2感染对HIV的影响在提供调整后的RR估计的研究中没有得到完全测量，可能是因为残余混杂。在HSV-2高度流行的地区，特别是非洲，这种贡献可能最大。针对HSV-2感染的新的预防性干预措施不仅可以通过降低疱疹性生殖器溃疡疾病的患病率来改善数百万人的生活质量，而且还可以对艾滋病毒的传播产生额外的间接影响。版权所有（C）2019世界卫生组织;许可人Elsevier。
Background A 2017 systematic review and meta-analysis of 55 prospective studies found the adjusted risk of HIV acquisition to be at least tripled in individuals with herpes simplex virus type 2 (HSV-2) infection. We aimed to assess the potential contribution of HSV-2 infection to HIV incidence, given an effect of HSV-2 on HIV acquisition.Methods We used a classic epidemiological formula to estimate the global and regional (WHO regional) population attributable fraction (PAF) and number of incident HIV infections attributable to HSV-2 infection by age (15-24 years, 25-49 years, and 15-49 years), sex, and timing of HSV-2 infection (established vs recently acquired). Estimates were calculated by incorporating HSV-2 and HIV infection data with pooled relative risk (RR) estimates for the effect of HSV-2 infection on HIV acquisition from a systematic review and meta-analysis. Because HSV-2 and HIV have shared sexual and other risk factors, in addition to HSV-related biological factors that increase HIV risk, we only used RR estimates that were adjusted for potential confounders.Findings An estimated 420 000 (95% uncertainty interval 317 000-546 000; PAF 29.6% [22.9-37.1]) of 1.4 million sexually acquired incident HIV infections in individuals aged 15-49 years in 2016 were attributable to HSV-2 infection. The contribution of HSV-2 to HIV was largest for the WHO African region (PAF 37.1% [28.7-46.3]), women (34.8% [23.5-45.0]), individuals aged 25-49 years (32.4% [25.4-40.2]), and established HSV-2 infection (26.8% [19.7-34.5]).Interpretation A large burden of HIV is likely to be attributable to HSV-2 infection, even if the effect of HSV-2 infection on HIV had been imperfectly measured in studies providing adjusted RR estimates, potentially because of residual confounding. The contribution is likely to be greatest in areas where HSV-2 is highly prevalent, particularly Africa. New preventive interventions against HSV-2 infection could not only improve the quality of life of millions of people by reducing the prevalence of herpetic genital ulcer disease, but could also have an additional, indirect effect on HIV transmission. Copyright (C) 2019 World Health Organization; licensee Elsevier.