Effect of HSV-2 infection on subsequent HIV acquisition: an updated systematic review and meta-analysis.
Effect of HSV-2 infection on subsequent HIV acquisition: an updated systematic review and meta-analysis.
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DOI：
10.1016/s1473-3099(17)30405-x
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发表时间：
2017-12
期刊：
影响因子：
--
通讯作者：
Boily MC
中科院分区：
文献类型：
--
作者：
Looker KJ;Elmes JAR;Gottlieb SL;Schiffer JT;Vickerman P;Turner KME;Boily MC
艾滋病毒和单纯疱疹病毒2型（HSV-2）感染造成了巨大的全球疾病负担，并且在流行病学上是相关的。之前两项关于HSV-2和HIV之间关系的系统性综述发现了HSV-2感染增加HIV感染风险的证据，但这些综述已经有十多年的历史了。对于这项系统性综述和荟萃分析，我们检索了PubMed、MEDLINE和Embase（2003年1月1日至2017年5月25日），以确定研究暴露于HSV-2感染后HIV感染风险的研究，无论是在基线（流行HSV-2感染）还是在随访期间（HSV-2感染事件）。如果研究是队列研究、对照试验或病例对照研究（包括嵌套在队列研究或临床试验中的病例对照研究）;如果研究评估了既存HSV-2感染对HIV感染的影响;如果研究使用类型特异性检测确定了研究参与者的HSV-2感染状态，则纳入研究。我们计算了流行或偶发HSV-2感染与HIV血清转换之间关联的合并随机效应估计值。我们还通过详细的荟萃回归和亚组分析扩展了以前的研究。特别是，我们调查了性别和风险组（一般人群与高危人群）对流行或偶发HSV-2感染后获得HIV的相对风险（RR）的影响。高危人群包括女性性工作者及其嫖客、男男性行为者、血清不一致的夫妇和性传播感染诊所的就诊者。我们确定了57项探索HSV-2和HIV之间关系的纵向研究。在一般人群中存在HSV-2流行感染的情况下，HIV感染几乎增加了两倍（校正RR 2.7，95% CI 2.2 - 3.4;估计数[Ne]=22），在高危人群中大约增加了一倍（1.7，1.4 - 2.1; Ne=25）。一般人群中HSV-2感染与获得HIV的最高风险相关（4.7，2.2 - 10.1; Ne=6）。在研究水平上对混杂因素的调整通常是不完整的，但对结果没有显著影响。我们发现研究估计值之间存在中度异质性，这可以通过风险组、世界地区和HSV-2暴露类型（流行与事件）来解释。我们发现的证据表明，HSV-2感染增加了艾滋病毒感染的风险。这一发现对诊断为HSV-2感染的个体的管理具有重要意义，特别是对于那些新感染的人。针对HSV-2的干预措施，如新的HSV疫苗，有可能对艾滋病毒产生额外的益处，这在合并感染发生率高的地区可能特别有效。世界卫生组织。
HIV and herpes simplex virus type 2 (HSV-2) infections cause a substantial global disease burden and are epidemiologically correlated. Two previous systematic reviews of the association between HSV-2 and HIV found evidence that HSV-2 infection increases the risk of HIV acquisition, but these reviews are now more than a decade old. For this systematic review and meta-analysis, we searched PubMed, MEDLINE, and Embase (from Jan 1, 2003, to May 25, 2017) to identify studies investigating the risk of HIV acquisition after exposure to HSV-2 infection, either at baseline (prevalent HSV-2 infection) or during follow-up (incident HSV-2 infection). Studies were included if they were a cohort study, controlled trial, or case-control study (including case-control studies nested within a cohort study or clinical trial); if they assessed the effect of pre-existing HSV-2 infection on HIV acquisition; and if they determined the HSV-2 infection status of study participants with a type-specific assay. We calculated pooled random-effect estimates of the association between prevalent or incident HSV-2 infection and HIV seroconversion. We also extended previous investigations through detailed meta-regression and subgroup analyses. In particular, we investigated the effect of sex and risk group (general population vs higher-risk populations) on the relative risk (RR) of HIV acquisition after prevalent or incident HSV-2 infection. Higher-risk populations included female sex workers and their clients, men who have sex with men, serodiscordant couples, and attendees of sexually transmitted infection clinics. We identified 57 longitudinal studies exploring the association between HSV-2 and HIV. HIV acquisition was almost tripled in the presence of prevalent HSV-2 infection among general populations (adjusted RR 2·7, 95% CI 2·2–3·4; number of estimates [Ne]=22) and was roughly doubled among higher-risk populations (1·7, 1·4–2·1; Ne=25). Incident HSV-2 infection in general populations was associated with the highest risk of acquisition of HIV (4·7, 2·2–10·1; Ne=6). Adjustment for confounders at the study level was often incomplete but did not significantly affect the results. We found moderate heterogeneity across study estimates, which was explained by risk group, world region, and HSV-2 exposure type (prevalent vs incident). We found evidence that HSV-2 infection increases the risk of HIV acquisition. This finding has important implications for management of individuals diagnosed with HSV-2 infection, particularly for those who are newly infected. Interventions targeting HSV-2, such as new HSV vaccines, have the potential for additional benefit against HIV, which could be particularly powerful in regions with a high incidence of co-infection. World Health Organization.
乌干达农村地区艾滋病毒感染率相对较低，但上升潜力很大：乌干达卡永加区的一项队列研究。
影响因子：
3.7
作者：
Guwatudde D;Wabwire-Mangen F;Eller LA;Eller M;McCutchan F;Kibuuka H;Millard M;Sewankambo N;Serwadda D;Michael N;Robb M;Kayunga Cohort Research Team
通讯作者：
Kayunga Cohort Research Team