Best of AIDS 2003: Epidemiology, Social, Cultural, and Political
Best of AIDS 2003: Epidemiology, Social, Cultural, and Political
Objectives: To quantify the association between prevalent or incident Herpes simplex virus type-2 (HSV2) infection and the incidence of HIV seroconversion among adults in the general population in rural Tanzania.
Study population: Adults aged 15-54 years sampled randomly from 12 rural communities in Mwanza Region, Tanzania and recruited to a randomized trial of improved treatment of sexually transmitted diseases ( Table 1 and Table 2 ).
Study design: Unmatched case control study nested within trial cohort.
Methods: Participants included 127 cases who seroconverted to HIV during the 2-year follow-up period and 636 randomly selected controls who remained HIV negative. Subjects were tested for HSV2 serology at baseline and follow-up, and associations between HIV and HSV2 were analysed with adjustment for socio-demographic and behavioural factors.
Results: After adjusting for confounding factors, a strong association between HSV2 infection and HIV seroconversion was observed in men (test for trend: P , 0.001), with adjusted odds ratios (OR) of 6.12 [95% confidence interval (CI), 2.52-14.9] in those HSV2 positive at baseline, and 16.8 (95% CI, 6.06-46.3) in those acquiring HSV2 infection during follow-up. A weaker association was observed in women (tests for trend: P = 0.14), with adjusted OR of 1.32 (95% CI, 0.62-2.78) and 2.36 (95% CI, 0.81-6.84), respectively. Population attributable fractions of incident HIV infection due to HSV2 were estimated as 74% in men and 22% in women.
Conclusions: The results suggest that HSV2 plays an important role in the transmission of HIV infection in this population. There is an urgent need to identify effective HSV2 control measures in order to reduce HIV incidence in Africa.
Dr. Pujades Rodriguez and colleagues from the London School of Hygiene and Tropical Medicine, showed in a recent study published in AIDS that men and women infected with Herpes simplex virus type-2 differ greatly in their risk of HIV acquisition.
A random sample of adults aged 15-54 years was selected from 12 rural communities in the Mwanza region of Tanzania to take part in a trial to improve treatment of sexually transmitted diseases. Men with genital herpes at the start of the study were six times more likely to become infected with HIV than those who were not infected with genital herpes. The risk increased to 16-fold among those who became infected with genital herpes during the study. No statistically significant association was observed among women between genital herpes infection and subsequent acquisition of HIV.
These results along with similar studies conducted around the world support the idea that genital herpes enhances susceptibility to HIV, especially in men. Rodriguez and his group believe there are number of effective ways to control genital herpes in order to reduce to HIV susceptibility. His team recommends three approaches to reduce genital herpes infection rates in Africa. Their approach is similar to that espoused by the Centers for Disease Control and Prevention in the USA.
One, better promotion of safer-sex practices and increased rates of male circumcision would help to reduce the incidence of genital herpes. However, the lag time will probably be long considering the large reservoir of infected individuals in countries such as Tanzania.
Two, although there is no cure for genital herpes, treatment that alleviates symptoms would be useful in reducing the frequency, duration, or severity of genital herpes. In high prevalence countries like Tanzania, however, the drugs would be expensive and any protocol would have difficulty identifying all those in need of treatment outside of high-risk groups.
Finally, there is an urgent need for a herpes vaccine. Vaccine development to date has been limited. For example, a vaccine under development in the USA has performed well in initial trials by preventing herpes disease in more than 70% of women, but with no clear effect in men. Even so, an effective and affordable vaccine for women may go a long way to curb the spread of genital herpes in African countries like Tanzania.
Ultimately, if Rodriguez and colleagues are correct, the curbing of genital herpes by these approaches would also reduce new HIV infections in Tanzania, a country where 1.5 million are already infected. As Headmistress Mwantumu Bakari Mahiza notes when referring to prevention AIDS efforts delivered to children at her primary school in Tanzania: "There is nothing strange to them. They live with infected neighbours, infected relatives, infected friends, and bury infected parents everyday. They know everything about AIDS, so they also need to know how to fight it," she explained."The earlier, the better".
Objectives: To quantify the association between prevalent or incident Herpes simplex virus type-2 (HSV2) infection and the incidence of HIV seroconversion among adults in the general population in rural Tanzania.
Study population: Adults aged 15-54 years sampled randomly from 12 rural communities in Mwanza Region, Tanzania and recruited to a randomized trial of improved treatment of sexually transmitted diseases ( Table 1 and Table 2 ).
Study design: Unmatched case control study nested within trial cohort.
Methods: Participants included 127 cases who seroconverted to HIV during the 2-year follow-up period and 636 randomly selected controls who remained HIV negative. Subjects were tested for HSV2 serology at baseline and follow-up, and associations between HIV and HSV2 were analysed with adjustment for socio-demographic and behavioural factors.
Results: After adjusting for confounding factors, a strong association between HSV2 infection and HIV seroconversion was observed in men (test for trend: P , 0.001), with adjusted odds ratios (OR) of 6.12 [95% confidence interval (CI), 2.52-14.9] in those HSV2 positive at baseline, and 16.8 (95% CI, 6.06-46.3) in those acquiring HSV2 infection during follow-up. A weaker association was observed in women (tests for trend: P = 0.14), with adjusted OR of 1.32 (95% CI, 0.62-2.78) and 2.36 (95% CI, 0.81-6.84), respectively. Population attributable fractions of incident HIV infection due to HSV2 were estimated as 74% in men and 22% in women.
Conclusions: The results suggest that HSV2 plays an important role in the transmission of HIV infection in this population. There is an urgent need to identify effective HSV2 control measures in order to reduce HIV incidence in Africa.
Dr. Pujades Rodriguez and colleagues from the London School of Hygiene and Tropical Medicine, showed in a recent study published in AIDS that men and women infected with Herpes simplex virus type-2 differ greatly in their risk of HIV acquisition.
A random sample of adults aged 15-54 years was selected from 12 rural communities in the Mwanza region of Tanzania to take part in a trial to improve treatment of sexually transmitted diseases. Men with genital herpes at the start of the study were six times more likely to become infected with HIV than those who were not infected with genital herpes. The risk increased to 16-fold among those who became infected with genital herpes during the study. No statistically significant association was observed among women between genital herpes infection and subsequent acquisition of HIV.
These results along with similar studies conducted around the world support the idea that genital herpes enhances susceptibility to HIV, especially in men. Rodriguez and his group believe there are number of effective ways to control genital herpes in order to reduce to HIV susceptibility. His team recommends three approaches to reduce genital herpes infection rates in Africa. Their approach is similar to that espoused by the Centers for Disease Control and Prevention in the USA.
One, better promotion of safer-sex practices and increased rates of male circumcision would help to reduce the incidence of genital herpes. However, the lag time will probably be long considering the large reservoir of infected individuals in countries such as Tanzania.
Two, although there is no cure for genital herpes, treatment that alleviates symptoms would be useful in reducing the frequency, duration, or severity of genital herpes. In high prevalence countries like Tanzania, however, the drugs would be expensive and any protocol would have difficulty identifying all those in need of treatment outside of high-risk groups.
Finally, there is an urgent need for a herpes vaccine. Vaccine development to date has been limited. For example, a vaccine under development in the USA has performed well in initial trials by preventing herpes disease in more than 70% of women, but with no clear effect in men. Even so, an effective and affordable vaccine for women may go a long way to curb the spread of genital herpes in African countries like Tanzania.
Ultimately, if Rodriguez and colleagues are correct, the curbing of genital herpes by these approaches would also reduce new HIV infections in Tanzania, a country where 1.5 million are already infected. As Headmistress Mwantumu Bakari Mahiza notes when referring to prevention AIDS efforts delivered to children at her primary school in Tanzania: "There is nothing strange to them. They live with infected neighbours, infected relatives, infected friends, and bury infected parents everyday. They know everything about AIDS, so they also need to know how to fight it," she explained."The earlier, the better".
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