Effect of HIV-1 and antiretroviral therapy on herpes simplex virus type 2: a prospective study in African women
Effect of HIV-1 and antiretroviral therapy on herpes simplex virus type 2: a prospective study in African women
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DOI：
10.1136/sti.2008.030692
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发表时间：
2008-10-01
影响因子：
3.6
通讯作者：
Van de Perre, P
中科院分区：
文献类型：
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作者：
Mayaud, P.;Nagot, N.;Van de Perre, P
目的：为了记录非洲 2 型单纯疱疹病毒 (HSV-2) 与 HIV 和高效抗逆转录病毒治疗 (HAART) 相关的自然史，对布基纳法索两项 HSV 抑制治疗随机对照试验的安慰剂组中的女性进行了一项纵向研究。方法：22 名未感染 HIV 的女性（第 1 组）、30 名接受 HAART 的 HIV-1 感染女性（第 2 组）和对 68 名不符合 HAART 资格的 HIV-1 感染女性（第 3 组）进行了为期 24 周的随访。每隔几周使用实时 PCR 从宫颈阴道灌洗液中检测到 HSV-2 DNA。每月测量血浆 HIV-1 RNA。入组时测量了 CD4 细胞计数。结果：第 1、2 和 3 组中，溃疡发生率分别为 1.9%、3.1% 和 7.2%（p = 0.02）。在 45.5%、63.3% 和 67.6% 的女性中检测到宫颈阴道 HSV-2 DNA（p = 0.11），三组中的就诊率分别为 4.3%、9.7% 和 15.5%（p < 0.001）。在感染 HIV 的女性中，宫颈阴道 HSV-2 DNA 在溃疡发作期间检出的频率较高（调整后风险比 (aRR) 2.79，95% CI 2.01 至 3.86），而在进行阴道冲洗的女性中检出频率较低（aRR 0.60，95% CI 0.40 至 0.91）。与未接受HAART且CD4细胞计数为500个细胞/μl或更高的女性相比，接受HAART的女性有相似的HSV-2脱落风险（aRR 0.95，95% CI 0.52至1.73），而CD4细胞计数为200-500个细胞/μl的女性更有可能脱落HSV-2（aRR 1.71，95% CI 1.02 至 2.86）。结论：HSV-2 再激活在 HIV 感染女性中更为频繁地发生，尤其是那些 CD4 细胞计数较低的女性，并且 HAART 仅部分减少了这种情况。 HSV 治疗可能会使 HIV 感染者在 HAART 期间受益。
Objectives: To document the natural history of herpes simplex virus type 2 (HSV-2) in relation to HIV and highly active antiretroviral therapy (HAART) in Africa, a longitudinal study was conducted of women in the placebo arms of two randomised controlled trials of HSV-suppressive therapy in Burkina Faso.Methods: 22 HIV-uninfected women (group 1), 30 HIV-1-infected women taking HAART (group 2), and 68 HIV-1-infected women not eligible for HAART (group 3) were followed over 24 weeks. HSV-2 DNA was detected on alternate weeks using real-time PCR from cervicovaginal lavages. Plasma HIV-1 RNA was measured every month. CD4 cell counts were measured at enrolment.Results: Ulcers occurred on 1.9%, 3.1% and 7.2% of visits in groups 1, 2 and 3 (p = 0.02). Cervicovaginal HSV-2 DNA was detected in 45.5%, 63.3% and 67.6% of women (p = 0.11), and on 4.3%, 9.7% and 15.5% of visits in the three groups (p < 0.001). Among HIV-infected women, cervicovaginal HSV-2 DNA was detected more frequently during ulcer episodes (adjusted risk ratio (aRR) 2.79, 95% CI 2.01 to 3.86) and less frequently among women practising vaginal douching (aRR 0.60, 95% CI 0.40 to 0.91). Compared with women not taking HAART and with CD4 cell counts of 500 cells/mu l or greater, women on HAART had a similar risk of HSV-2 shedding (aRR 0.95, 95% CI 0.52 to 1.73), whereas women with CD4 cell counts of 200-500 cells/mu l were more likely to shed HSV-2 (aRR 1.71, 95% CI 1.02 to 2.86).Conclusions: HSV-2 reactivations occur more frequently among HIV-infected women, particularly those with low CD4 cell counts, and are only partly reduced by HAART. HSV therapy may benefit HIV-infected individuals during HAART.