Roles of clinical and subclinical reactivated herpes simplex virus type 2 infection and Human Immunodeficiency Virus type 1 (HIV-1)-induced immunosuppression on genital and plasma HIV-1 levels

Background. Few longitudinal studies have described the interactions between reactivation of herpes simplex virus type 2 (HSV-2) infection (hereafter, "HSV-2 reactivation") and genital and systemic replication of human immunodeficiency virus type 1 (HIV-1). Methods. Women in Burkina Faso who were seropositive for both HIV-1 and HSV-2 were enrolled in a randomized placebo-controlled trial of therapy to suppress reactivation of HSV-2 infection (hereafter, "HSV suppressive therapy"). During the baseline phase, 6 enriched cervicovaginal lavage specimens were obtained over 12 weeks to detect and quantify the HIV-1 RNA and HSV-2 DNA loads. Results. Women with genital ulcer disease (GUD) detected at least once were more likely than women in whom GUD was not detected (risk ratio [RR], 1.23;95% confidence interval [CI], 1.09-1.37) to have genital HIV-1 RNA detected during ≥1 visit. Similarly, women with genital HSV-2 DNA detected during ≥1 clinic visit were more likely than women in whom genital HSV-2 DNA was not detected (RR, 1.17; 95% CI, 1.01-1.34) to have genital HIV-1 RNA detected at least once. In addition, the mean genital HIV-1 RNA loads for women with GUD detected during ≥1 visit and women with HSV-2 genital shedding detected during ≥1 visit were greater than that for women in whom genital HSV-2 DNA or GUD was never detected. The plasma HIV-1 RNA load was increased among women for whom ≥1 visit revealed GUD (+0.25 log10 copies/mL; 95% CI, -0.05-0.55) or genital HSV-2 DNA (+0.40 log10 copies/mL; 95% CI, 0.15-0.66), compared with women who did not experience GUD or HSV-2 genital shedding, respectively. The association of HSV-2 reactivations on HIV-1 replication tended to be stronger in patients with a higher CD4+ cell count (i.e., >500 cells/μL). The contribution of HSV-2 to HIV-1 replication among women with CD4+ cell count of ≤500 cells/μL was reduced because almost all experienced HIV-1 genital shedding. Conclusions. Both clinical and subclinical HSV-2 reactivations play a role in increasing the rate of HIV-1 replication. HSV suppressive therapy is a promising tool for HIV control. Initiation of such therapy when the CD4+ cell count is >500 cells/μL deserves further investigation. Clinical trials registration. The ANRS 1285 Study is registered with the National Institutes of Health (registration number NCT00158509). © 2008 by the Infectious Diseases Society of America. All rights reserved.