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P80 Predictors of Unsuspected HSV-2 Seropositivity Among Persons Attending An HIV-Care Clinic

Wednesday, March 14, 2012
Hyatt Exhibit Hall
Nicholas Van Wagoner, MD, PhD1, Elizabeth Brown, PhD, MPH2, Richard Whitley, MD3 and Edward W. Hook III, MD1, 1Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, 2Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 3Division of Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL

Background: Herpes simplex virus type 2 (HSV-2) infection is common in persons with HIV.  As in other populations, most HIV-infected persons with HSV-2 are unaware that they are infected with this virus.  Although well-characterized in the general population, factors associated with undiagnosed HSV-2 infection in HIV-infected populations is less well understood.

Objectives:  Our objectives were to determine the seroprevalence of undiagnosed HSV-2 and to identify correlates of HSV-2 infection in HIV-infected persons.

Methods:  HIV-infected volunteers without known ano-genital HSV-2 were serologically screened for evidence of HSV-2 infection.  We evaluated demographic and behavioral characteristics, STI history, and characteristics of HIV infection to evaluate variables associated with co-infection using logistic regression.

Results: HSV-2 seroprevalence was 61%.  Women (P = 0.01), African Americans (P=0.001), and older persons (P=0.005) were more likely to be HSV-2 infected.  No differences were observed for HIV risk factor, HIV viral load or CD4 count by HSV-2 serostatus.  Illicit drug users were more likely to have coinfection with HIV and HSV-2 (OR1.86, 95% CI 1.13-3.08) and this association was more pronounced among heroin/opiate users (OR=4.73, 95% CI 1.27-17.56; P=0.02).  STI history (OR=2.29, 95% CI 1.35-3.88) and specifically gonorrhea (OR=2.36, 95% CI 1.03-5.36), syphilis (OR=2.48, 95% CI 1.27-2.85), or Hepatitis B (OR=2.65, 95% CI 1.24-5.66) was more common in persons with HIV/HSV-2 co-infection.  In multivariable analysis, syphilis history (OR=2.05, 95% CI 1.01-4.16), HBV infection (OR=2.26, 95% CI 1.03-4.97) and previous or current use of heroin or opiates (OR=5.11, 95% CI 1.33-19.61) remained statistically significant.

Conclusions:  Although the seroprevalence of HSV-2 is higher in HIV-infected patients, previously established predictors of HSV-2 seropositivity apply to this population.

Implications for Programs, Policy, and Research:  Predictors of HSV-2 infection are similar between HIV-infected and uninfected persons and may be used in screening strategies to identify those at greatest risk for HSV-2 infection.

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