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Owen EM, Jama M, Nahal B, Clarke E, Obasi A. 20 years of herpes simplex virus type 2 (HSV-2) research in low-income and middle-income countries: systematic evaluation of progress made in addressing WHO priorities for research in HSV-2/HIV interactions, HSV-2 control and mathematical modelling. BMJ Glob Health 2024; 9:e015167. [PMID: 38964882 PMCID: PMC11227757 DOI: 10.1136/bmjgh-2024-015167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/14/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Reviewing and updating research priorities is essential to assess progress and to ensure optimal allocation of financial and human resources in research. In 2001, WHO held a research priority setting workshop for herpes simplex virus type 2 (HSV-2) research in low-income and middle-income countries (LMICs). This study aimed to describe progress between 2000 and 2020 in three of the five key research priority areas outlined in the workshop: HSV-2/HIV interactions, HSV-2 control measures and HSV-2 mathematical modelling. The remaining priorities are addressed in a companion paper. METHOD A systematic literature search of MEDLINE, CINAHL, Global Health and Cochrane databases was carried out. Relevant primary research studies based in LMICs, written in English and published on 2000-2020 were included. Papers were screened by two independent reviewers, and suitable variables were selected for manual extraction from study texts. Data were organised into an Excel spreadsheet and analysed using IBM SPSS. RESULTS In total, 3214 discrete papers were identified, of which 180 were eligible for inclusion (HSV-2/HIV interactions, 98; control measures, 58; mathematical modelling, 24). Most studies were conducted in East Africa. The majority of the 2001 WHO HSV-2 research priorities were addressed at least in part. Overall, despite several studies describing a strong relationship between HSV-2 and the acquisition and transmission of HIV, HSV-2 control repeatedly demonstrated little effect on HIV shedding or transmission. Further, although mathematical modelling predicted that vaccines could significantly impact HSV-2 indicators, HSV-2 vaccine studies were few. Studies of antiviral resistance were also few. CONCLUSION Since 2000, LMIC HSV-2 research addressing its control, HIV interactions and mathematical modelling has largely addressed the priorities set in the 2001 WHO HSV-2 workshop. However, key knowledge gaps remain in vaccine research, antiviral cost-effectiveness, antiviral resistance and specific geographical areas.
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Affiliation(s)
- Ela Mair Owen
- Liverpool School of Tropical Medicine, Liverpool, UK
- University of Liverpool, Liverpool, UK
| | - Muna Jama
- Liverpool School of Tropical Medicine, Liverpool, UK
- International Rescue Committee, Mogadishu, Somalia
| | - Belinder Nahal
- University of Liverpool, Liverpool, UK
- London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Clarke
- University of Liverpool, Liverpool, UK
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Angela Obasi
- Liverpool School of Tropical Medicine, Liverpool, UK
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Aravantinou M, Plagianos M, Kokogho A, Adebajo S, Nowak RG, Shoyemi E, Ekeh C, Lombardi K, Peel SA, Baral SD, Crowell TA, Derby N, Teleshova N, Martinelli E. Herpes Simplex Virus Type 2 Prevalence and Association with Inflammatory Cytokines Among Sexual and Gender Minorities Living With and Without HIV-1 from Lagos, Nigeria. AIDS Res Hum Retroviruses 2023; 39:485-494. [PMID: 36825536 PMCID: PMC10510689 DOI: 10.1089/aid.2022.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Herpes simplex virus type 2 (HSV-2) is common globally and contributes significantly to the risk of acquiring HIV-1, yet these two sexually transmitted infections have not been sufficiently characterized for sexual and gender minorities (SGM) across Sub-Saharan Africa. To help fill this gap, we performed a retrospective study using plasma and serum samples from 183 SGM enrolled at the Lagos site of the TRUST/RV368 cohort in Nigeria, assayed them for HSV-2 antibodies with the Kalon ELISA and plasma cytokines and chemokines with Luminex, and correlated the findings with HIV-1 viral loads (VLs) and CD4 counts. We found an overall HSV-2 prevalence of 36.6% (49.5% and 23.9% among SGM with and without HIV-1, respectively, p < .001). Moreover, HSV-2-positive status was associated with high circulating concentrations of CCL11 among antiretroviral therapy-treated (p = .031) and untreated (p = .015) participants, and with high concentrations of CCL2 in the untreated group (p = .004), independent of VL. Principal component analysis revealed a strong association of cytokines with HIV-1 VL independent of HSV-2 status. In conclusion, our study finds that HSV-2 prevalence among SGM with HIV-1 is twice as high than HSV-2 prevalence among SGM without HIV-1 in Lagos and suggests that this is associated with higher levels of certain systemic cytokines. Additional work is needed to further characterize the relationship between HSV-2 and HIV-1 in SGM and help develop targeted therapies for coinfected individuals.
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Affiliation(s)
- Meropi Aravantinou
- Center for Biomedical Research, Population Council, New York, New York, USA
| | - Marlena Plagianos
- Center for Biomedical Research, Population Council, New York, New York, USA
| | | | - Sylvia Adebajo
- Center for International Health Education and Biosecurity (CIHEB), University of Maryland, Baltimore, Maryland, USA
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland, Baltimore, Maryland, USA
| | | | | | - Kara Lombardi
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Sheila A. Peel
- Diagnostics and Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Stefan D. Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Nina Derby
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Natalia Teleshova
- Center for Biomedical Research, Population Council, New York, New York, USA
| | - Elena Martinelli
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Govender Y, Morrison CS, Chen PL, Gao X, Yamamoto H, Chipato T, Anderson S, Barbieri R, Salata R, Doncel GF, Fichorova RN. Cervical and systemic innate immunity predictors of HIV risk linked to genital herpes acquisition and time from HSV-2 seroconversion. Sex Transm Infect 2023; 99:311-316. [PMID: 36104248 PMCID: PMC10011014 DOI: 10.1136/sextrans-2022-055458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/25/2022] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To examine innate immunity predictors of HIV-1 acquisition as biomarkers of HSV-2 risk and biological basis for epidemiologically established HIV-1 predisposition in HSV-2 infected women. METHODS We analysed longitudinal samples from HIV-1 negative visits of 1019 women before and after HSV-2 acquisition. We measured cervical and serum biomarkers of inflammation and immune activation previously linked to HIV-1 risk. Protein levels were Box-Cox transformed and ORs for HSV-2 acquisition were calculated based on top quartile or below/above median levels for all HSV-2 negative visits. Bivariate analysis determined the likelihood of HSV-2 acquisition by biomarker levels preceding infection. Linear mixed-effects models evaluated if biomarkers differed by HSV-2 status defined as negative, incident or established infections with an established infection cut-off starting at 6 months. RESULTS In the cervical compartment, two biomarkers of HIV-1 risk (low SLPI and high BD-2) also predicted HSV-2 acquisition. In addition, HSV-2 acquisition was associated with IL-1β, IL-6, IL-8, MIP-3α, ICAM-1 and VEGF when below median levels. Systemic immunity predictors of HSV-2 acquisition were high sCD14 and IL-6, with highest odds when concomitantly increased (OR=2.23, 1.49-3.35). Concomitant systemic and mucosal predictors of HSV-2 acquisition risk included (1) serum top quartile sCD14 with cervical low SLPI, VEGF and ICAM-1, or high BD-2; (2) serum high IL-6 with cervical low VEGF and ICAM-1, SLPI, IL-1β and IL-6; and (3) serum low C reactive protein with cervical high BD-2 (the only combination also predictive of HIV-1 acquisition). Most cervical biomarkers were decreased after HSV-2 acquisition compared with the HSV-2 negative visits, with incident infections associated with a larger number of suppressed cervical biomarkers and lower serum IL-6 levels compared with established infections. CONCLUSIONS A combination of systemic immunoinflammatory and cervical immunosuppressed states predicts HSV-2 acquisition. A persistently suppressed innate immunity during incident HSV-2 infection may add to the increased HIV-1 susceptibility.
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Affiliation(s)
- Yashini Govender
- Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Charles S Morrison
- Global Health and Population Research, FHI 360, Durham, North Carolina, USA
| | - Pai-Lien Chen
- Global Health and Population Research, FHI 360, Durham, North Carolina, USA
| | - Xiaoming Gao
- Global Health and Population Research, FHI 360, Durham, North Carolina, USA
| | - Hidemi Yamamoto
- Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tsungai Chipato
- Obstetrics and Gynecology, University of Zimbabwe, Harare, Zimbabwe
| | - Sharon Anderson
- Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Robert Barbieri
- Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Salata
- Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Gustavo F Doncel
- Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
- CONRAD, Arlington, Virginia, USA
| | - Raina Nakova Fichorova
- Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Chang W, Jiao X, Sui H, Goswami S, Sherman BT, Fromont C, Caravaca JM, Tran B, Imamichi T. Complete Genome Sequence of Herpes Simplex Virus 2 Strain G. Viruses 2022; 14:v14030536. [PMID: 35336943 PMCID: PMC8954253 DOI: 10.3390/v14030536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/22/2022] [Accepted: 03/03/2022] [Indexed: 12/13/2022] Open
Abstract
Herpes simplex virus type 2 (HSV-2) is a common causative agent of genital tract infections. Moreover, HSV-2 and HIV infection can mutually increase the risk of acquiring another virus infection. Due to the high GC content and highly repetitive regions in HSV-2 genomes, only the genomes of four strains have been completely sequenced (HG52, 333, SD90e, and MS). Strain G is commonly used for HSV-2 research, but only a partial genome sequence has been assembled with Illumina sequencing reads. In the current study, we de novo assembled and annotated the complete genome of strain G using PacBio long sequencing reads, which can span the repetitive regions, analyzed the ‘α’ sequence, which plays key roles in HSV-2 genome circulation, replication, cleavage, and packaging of progeny viral DNA, identified the packaging signals homologous to HSV-1 within the ‘α’ sequence, and determined both termini of the linear genome and cleavage site for the process of concatemeric HSV-2 DNA produced via rolling-circle replication. In addition, using Oxford Nanopore Technology sequencing reads, we visualized four HSV-2 genome isomers at the nucleotide level for the first time. Furthermore, the coding sequences of HSV-2 strain G have been compared with those of HG52, 333, and MS. Moreover, phylogenetic analysis of strain G and other diverse HSV-2 strains has been conducted to determine their evolutionary relationship. The results will aid clinical research and treatment development of HSV-2.
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Affiliation(s)
- Weizhong Chang
- Laboratory of Human Retrovirology and lmmunoinformatics, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (X.J.); (H.S.); (S.G.); (B.T.S.)
- Correspondence: (W.C.); (T.I.); Tel.: +1-(301)-846-6295 (W.C.); +1-(301)-846-5450 (T.I.)
| | - Xiaoli Jiao
- Laboratory of Human Retrovirology and lmmunoinformatics, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (X.J.); (H.S.); (S.G.); (B.T.S.)
| | - Hongyan Sui
- Laboratory of Human Retrovirology and lmmunoinformatics, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (X.J.); (H.S.); (S.G.); (B.T.S.)
| | - Suranjana Goswami
- Laboratory of Human Retrovirology and lmmunoinformatics, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (X.J.); (H.S.); (S.G.); (B.T.S.)
| | - Brad T. Sherman
- Laboratory of Human Retrovirology and lmmunoinformatics, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (X.J.); (H.S.); (S.G.); (B.T.S.)
| | - Caroline Fromont
- Sequencing Facility, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (C.F.); (J.M.C.); (B.T.)
| | - Juan Manuel Caravaca
- Sequencing Facility, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (C.F.); (J.M.C.); (B.T.)
| | - Bao Tran
- Sequencing Facility, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (C.F.); (J.M.C.); (B.T.)
| | - Tomozumi Imamichi
- Laboratory of Human Retrovirology and lmmunoinformatics, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA; (X.J.); (H.S.); (S.G.); (B.T.S.)
- Correspondence: (W.C.); (T.I.); Tel.: +1-(301)-846-6295 (W.C.); +1-(301)-846-5450 (T.I.)
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Groves AK, Bhushan NL, Stoner MCD, Gómez-Olivé FX, Kahn K, Pettifor AE. HIV and Herpes Simplex Virus Type 2 Incidence Among Adolescent Mothers in South Africa: A Longitudinal Analysis of HIV Prevention Trials Network 068 Data. J Acquir Immune Defic Syndr 2022; 89:e23-e29. [PMID: 34855627 PMCID: PMC8837695 DOI: 10.1097/qai.0000000000002872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescent motherhood is common in South Africa and occurs against a backdrop of high HIV risk. While childbearing during adolescence may result in social and economic strain that may negatively impact health, there has been limited study of whether adolescent motherhood increases the risk of HIV or herpes simplex virus type 2 (HSV-2) acquisition or engagement in high-risk sexual partnerships. SETTING Data are from HIV Prevention Trials Network 068, a longitudinal conditional cash transfer study of adolescent girls and young women (age, 13-23) in rural South Africa. METHODS We used survival analysis to estimate hazard ratios to determine if adolescent motherhood (live birth before 20 years) predicted incident HIV and incident HSV-2 and generalized estimating equations for behavioral risk ratios to determine if adolescent motherhood was associated with transactional sex and age-disparate partnerships. RESULTS Of 2452 adolescent girls and young women who were HIV negative at baseline, 5% were adolescent mothers; 16% were adolescent mothers by the end of the study period. After controlling for covariates, adolescent motherhood predicted incident HSV-2 acquisition [ adjusted hazard ratios, 1.30; 95% confidence interval (CI): 1.01 to 1.95] but not HIV acquisition ( adjusted hazard ratios, 1.19; 95% CI, 0.76 to 1.86). Adolescent motherhood was also associated with being in an age-disparate partnership (adjusted risk ratio, 1.30; 95% CI: 1.07 to 1.58) but not transactional sex. CONCLUSION Adolescent motherhood increased the risk of HSV-2 and engagement in age-disparate partnerships, both known risk factors for HIV infection. Sexually transmitted infection screening and/or tailored combination HIV prevention interventions that account for the context of adolescent motherhood are critical to maximize adolescent mothers' long-term health and to meet UNAIDS 95-95-95 targets by 2030.
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Affiliation(s)
- Allison K Groves
- Department of Community Health and Prevention, Drexel University, Philadelphia, PA
| | | | - Marie C D Stoner
- Women's Global Health Imperative, RTI International, Berkeley, CA
| | - Francesc X Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa; and
- INDEPTH Network, Accra, Ghana
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa; and
- INDEPTH Network, Accra, Ghana
| | - Audrey E Pettifor
- University of North Carolina at Chapel Hill, Chapel Hill, NC
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa; and
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Alshehri AM, Ahmed Alamri MM, Mahdi Alharazi AA, Essa Alhazmi AM, Hassan Alfaqih RM, Alzaylaee AAI, Harb Awadh Almarhabi S, Alfaqih HMH, Ali Khneen Alderhami A, Almarhabi MHA, Alsllami A. The Awareness of the Human Papillomavirus Infection and Oropharyngeal Cancer in People to Improve the Health Care System at Al Qunfudhah Region, Kingdom of Saudi Arabia. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5185075. [PMID: 34712459 PMCID: PMC8548161 DOI: 10.1155/2021/5185075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/26/2021] [Accepted: 09/16/2021] [Indexed: 11/18/2022]
Abstract
With 14 million new infections each year, the human papillomavirus (HPV) is the most common sexually transmitted infection (STI) among both men and women in the United States (US). Infections with the human papillomavirus (HPV) are responsible for a considerable portion of the global cancer burden. HPV-related oral malignancies are on the rise around the world, according to epidemiological studies. To provide accurate advice to their patients, dental practitioners require thorough, up-to-date HPV-related knowledge. Methods. In this cross-sectional study, data were collected by the purposely constructed questionnaire. A questionnaire composed of the demographic items and items related to the awareness and knowledge about Human papillomavirus. The questionnaire was constructed after a series of discussions between the panel of experts. This panel was composed of a subject specialist, researcher, and language expert. The Cronbach alpha of the questionnaire was calculated. The study will be conducted in the Al Qunfudhah. Results. The Cronbach alpha of the questionnaire was 0.72. Out of a total of 550 respondents, with a mean (SD) age of 47.5 (11.5), the female respondents were 167 (30.4%) while male were 383 (69.6%). 20.5% of the respondents (out of 550) were having awareness of HPV. Implications. Knowledge of HPV-related oral cancer is critical, and it is advised to be taught as part of dental students' basic curriculum and clinical training. This problem can be solved by better educational training programs. Knowledge of HPV-related oral cancer is critical, and it is advised to be taught as part of dental students' basic curriculum and clinical training.
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Affiliation(s)
- Ali Maeed Alshehri
- Otolaryngology College of Medicine, King Khalid University, Abha, Saudi Arabia
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Wand H, Moodley J, Reddy T, Naidoo S. Impact of recurrent sexually transmitted infections on HIV seroconversion: Results from multi-state frailty models. Int J STD AIDS 2021; 32:1308-1317. [PMID: 34392715 DOI: 10.1177/09564624211036587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
After several decades of research, South Africa is still considered to be the epicentre of HIV epidemic. The country also has the highest burden of sexually transmitted infections (STIs) which have been frequently linked to increasing rates of HIV transmission due to biological and behavioural associations between these two pathogeneses. We investigated the cumulative impact of recurrent STIs on subsequent HIV seroconversion among a cohort of South African women. We used the 'frailty' models which can account for the heterogeneity due to the recurrent STIs in a longitudinal setting. The lowest HIV incidence rate was 5.0/100 person-year among women who had no baseline STI and remained negative during the follow-up. This estimate was three times higher among those who had recurrent STIs in the follow-up period regardless of their STI status at baseline (15.8 and 14.0/100 person-year for women with and without STI diagnosis at baseline, respectively). Besides younger age and certain partnership characteristics, our data provided compelling evidence for the impact of recurrent STI. diagnoses on increasing rates of HIV. At the population-level, 65% of HIV infections collectively associated with recurrent STIs. These results have significant clinical and epidemiological implications and may play critical role in the trajectory of the infections in the region.
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Affiliation(s)
- Handan Wand
- Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Jayajothi Moodley
- HIV Prevention Research Unit, 59097South African Medical Research Council, KwaZulu-Natal, South Africa.,The Aurum Institute, Johannesburg, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, 59097South African Medical Research Council, Durban, South Africa
| | - Sarita Naidoo
- HIV Prevention Research Unit, 59097South African Medical Research Council, KwaZulu-Natal, South Africa.,The Aurum Institute, Johannesburg, South Africa
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Nowak RG, Liska TA, Bentzen SM, Kim E, Chipato T, Salata RA, Celentano DD, Morrison CS, Gravitt PE. Brief Report: Herpes Simplex Virus Type-2 Shedding and Genital Ulcers During Early HIV in Zimbabwean Women. J Acquir Immune Defic Syndr 2021; 87:789-793. [PMID: 33587502 PMCID: PMC8131209 DOI: 10.1097/qai.0000000000002641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Herpes simplex virus type-2 (HSV-2) seropositive persons have a 3- to 5-fold higher risk of acquiring HIV, possibly because of HSV-2-induced inflammation and recruitment of susceptible immune cells to exposure sites. We hypothesized that cervical HSV-2 activation (ie, viral DNA shedding and/or ulcers) preceded HIV acquisition in the hormonal contraception and HIV cohort. METHODS Zimbabwean women who acquired HIV were matched to HIV-negative women on visit, age, and bacterial sexually transmitted infections. Up to 5 cervical swabs bracketing first polymerase chain reaction detection of HIV DNA (the index visit) were selected (t-6months, t-3months, tindex, t+3months, t+6months). Women with HSV-2 immunoglobulin G+ before tindex were polymerase chain reaction tested for viral shedding. Self-reported and clinician-diagnosed ulcers were documented. Multivariable logistic regression, accounting for matching, estimated adjusted odds ratios (aOR) and 95% confidence intervals (CIs) at each visit. RESULTS Of 387 HSV-2 seropositive women, most had prevalent as compared with incident HSV-2 (91% vs. 9%, respectively). HSV-2 viral shedding was more common among HIV seroconverters than HIV-negative women (26% vs. 14%, P < 0.01). Shedding occurred around HIV acquisition (t-3months aOR, 2.7; 95% CI, 0.8 to 8.8; tindex aOR, 2.6; 95% CI, 1.1 to 6.5; t+3months aOR, 2.6; 95% CI, 1.0 to 6.6). Genital ulcers were reported more often among HIV seroconverters than HIV-negative women (13% vs. 7%; P = 0.06) and detection was after HIV acquisition (t+6months aOR, 14.5; 95% CI, 1.6 to 133.9). CONCLUSIONS HSV-2 shedding appeared synergistic with HIV acquisition followed by presentation of ulcers. Evaluating all sexually transmitted infections rather than HSV-2 alone may clarify the relationship between inflammation and HIV acquisition.
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Affiliation(s)
- Rebecca G Nowak
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD
| | - Tobias A Liska
- Nathan Schnaper Internship Program in Translational Cancer Research, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD
| | - Søren M Bentzen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Esther Kim
- Beth Israel Lahey Health Beverly Hospital, Beverly MA
| | - Tsungai Chipato
- Department of Obstetrics and Gynecology, University of Zimbabwe, Harare, Zimbabwe
| | - Robert A Salata
- Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | | | - Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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McCloskey LA, Hitchcock S, Eloff I, Dinh P, Masemola K. The role of reproductive coercion in women's risk for HIV: A case-control study of outpatients in Gauteng, South Africa. Int J Gynaecol Obstet 2020; 151:377-382. [PMID: 32931016 DOI: 10.1002/ijgo.13373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/31/2020] [Accepted: 09/10/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To investigate how reproductive coercion, or men's attempts to control their partners' use of contraception, may contribute to adverse reproductive health outcomes for women including abortions, sexually transmitted infections, and HIV for young women in South Africa. METHODS Findings are based on a case-control interview study of 882 South African women outpatients aged 15-29 years, 48.5% (n=427) of whom were HIV seropositive. Covariates include demographics, intimate partner violence, sexually transmitted infections, having an abortion, using long-acting reversible contraception, and unequal sexual relationship power. RESULTS Most covariates with the exceptions of abortion and unequal relationship power increase the risk of HIV, and all relate to reproductive coercion. Intimate partner violence is strongly associated with reproductive coercion (odds ratio 3.86, 95% confidence interval 2.89-5.15). When intimate partner violence is included in the full model reproductive coercion remains a significant predictor of HIV by 42%, and acts as a partial mediator between IPV and HIV. CONCLUSION Findings confirm the significance of reproductive coercion as a risk marker for HIV. Reproductive coercion undermines women's reproductive health and warrants clinical intervention. Recommendations are offered for clinical practice within the South African context to increase training and assessment and provide covert long-acting reversible contraception as one pathway towards promoting women's reproductive autonomy.
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Affiliation(s)
| | - Sonia Hitchcock
- University of Pretoria College of Health Sciences, Pretoria, South Africa
| | - Irma Eloff
- Department of Educational Psychology, University of Pretoria Faculty of Education, Pretoria, South Africa
| | - Paul Dinh
- Indiana University College of Medicine, Indianapolis, IN, USA
| | - Khomotso Masemola
- University of Pretoria College of Health Sciences, Pretoria, South Africa
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Kharsany ABM, McKinnon LR, Lewis L, Cawood C, Khanyile D, Maseko DV, Goodman TC, Beckett S, Govender K, George G, Ayalew KA, Toledo C. Population prevalence of sexually transmitted infections in a high HIV burden district in KwaZulu-Natal, South Africa: Implications for HIV epidemic control. Int J Infect Dis 2020; 98:130-137. [PMID: 32562845 PMCID: PMC7484252 DOI: 10.1016/j.ijid.2020.06.046] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) and Human immunodeficiency virus (HIV) share a complex bidirectional relationship, however, population prevalence and the association between the presence of STIs and HIV in a high HIV burden district in KwaZulu-Natal, South Africa is not known. METHODS A total of 9812 participants aged 15-49 years were enrolled in a cross-sectional population-based household survey. Participants completed a structured questionnaire and provided first-pass urine (males) or self-collected vulvo-vaginal swabs (females) for the detection of STIs. RESULTS Prevalence of herpes simplex virus type-2 (HSV-2) was 57.8%, syphilis was 1.6%, Neisseria gonorrhoeae was 2.8%, Chlamydia trachomatis was 7.1%, Trichomonas vaginalis was 9.0%, Mycoplasma genitalium was 5.5% and HIV was 36.3%. HIV positive status was associated with an increased probability of having M. genitalium (aPR = 1.49, 95% CI 1.02-2.19) among males and syphilis (aPR = 2.54, 95% CI 1.32-4.86), N. gonorrhoeae (aPR = 2.39, 95% CI 1.62-3.52), T. vaginalis (aPR = 1.70, 95% CI 1.43-2.01) and M. genitalium (aPR = 1.60, 95% CI 1.15-2.22) among females. HIV viral load ≥400 copies per mL was associated with an increased probability of N. gonorrhoeae (aPR = 1.91, 95% CI 1.36-2.70), C. trachomatis (aPR = 1.52, 95% CI 1.12-2.05) and M. genitalium (aPR = 1.83, 95% CI 1.27-2.63). CONCLUSIONS The high prevalence of STIs and the association between STIs and HIV, and HIV viral load underscores the public health implications of sustained transmission risk of STIs and HIV. These findings highlight the urgent need for expanding STI surveillance and implementing interventions to monitor and reduce the STI burden.
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Affiliation(s)
- Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; School of Laboratory Medicine & Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa.
| | - Lyle R McKinnon
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Lara Lewis
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Cherie Cawood
- Epicentre AIDS Risk Management (Pty) Limited, Cape Town, South Africa
| | - David Khanyile
- Epicentre AIDS Risk Management (Pty) Limited, Cape Town, South Africa
| | - Domiciled Venessa Maseko
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service (NICD/NHLS), Johannesburg, South Africa
| | - Tawni C Goodman
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Sean Beckett
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | | | - Carlos Toledo
- Centers for Disease Control and Prevention (CDC), Atlanta, United States
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11
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Ng'wamkai G, Msigwa KV, Chengula D, Mgaya F, Chuma C, Msemwa B, Silago V, Majigo M, Mshana SE, Mirambo MM. Treponema pallidum infection predicts sexually transmitted viral infections (hepatitis B virus, herpes simplex virus-2, and human immunodeficiency virus) among pregnant women from rural areas of Mwanza region, Tanzania. BMC Pregnancy Childbirth 2019; 19:392. [PMID: 31664945 PMCID: PMC6820934 DOI: 10.1186/s12884-019-2567-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) is a global health problem with increased risk and morbidities during pregnancy. This study investigated the magnitude of viral STIs among pregnant women from three rural hospitals/clinics providing antenatal care in Mwanza region, Tanzania. METHODS Between February and May 2018, a total of 499 pregnant women were enrolled and tested for Human immunodeficiency virus (HIV), Herpes simplex virus-2 (HSV-2), Hepatitis B virus (HBV) and Hepatitis C virus (HCV) using rapid immunochromatographic tests and for syphilis using non-treponemal and treponemal antibody test. RESULTS The median age of enrolled women was 25 (IQR: 22-31) years. Seventy eight (15.6, 95% CI: 12-18) of women tested had at least one sexually transmitted viral infection. Specific prevalence of HIV, HBV, HCV, HSV-2 IgG and HSV-2 IgM were found to be 25(5.0%), 29(5.8%), 2(0.4%), 188(37.7%) and 24(4.8%), respectively. The odds of having viral infection was significantly high among women with positive T. pallidum serostatus (adjusted odd ratio (aOR): 3.24, 95%CI; 1.2-85). By multivariable logistic regression analysis, history of STIs predicted HSV-2 IgM seropositivity (aOR: 3.70, 95%CI: 1.43-9.62) while parity (aOR: 1.23, 95%CI: 1.04-1.46) predicted HBV infection and syphilis positive results (aOR: 8.63, 95%CI: 2.81-26.45) predicted HIV infection. CONCLUSION A significant proportion of pregnant women in rural areas of Mwanza region has at least one sexually transmitted viral infection which is independently predicted by positive T. pallidum serostatus. The strengthening and expansion of ANC screening package to include screening of STIs will ultimately reduce the viral STIs among pregnant women hence reduce associated morbidities and mortalities.
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Affiliation(s)
- Gilbert Ng'wamkai
- Department of Obstetrics and Gynecology, Bugando Medical Centre, P.O. Box 370, Mwanza, Tanzania
| | - Kalista V Msigwa
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Damas Chengula
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Frank Mgaya
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Clotilda Chuma
- Department of Obstetrics and Gynecology, Bugando Medical Centre, P.O. Box 370, Mwanza, Tanzania
| | - Betrand Msemwa
- Institute of Allied Health Sciences, Catholic University of Health and Allied sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Mtebe Majigo
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Mariam M Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, P.O. Box 1464, Mwanza, Tanzania.
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12
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Bradley J, Floyd S, Piwowar-Manning E, Laeyendecker O, Young A, Bell-Mandla N, Bwalya J, Bock P, Fidler S, Ayles H, Hayes RJ. Sexually Transmitted Bedfellows: Exquisite Association Between HIV and Herpes Simplex Virus Type 2 in 21 Communities in Southern Africa in the HIV Prevention Trials Network 071 (PopART) Study. J Infect Dis 2019; 218:443-452. [PMID: 29659909 PMCID: PMC6049005 DOI: 10.1093/infdis/jiy178] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/05/2018] [Indexed: 01/30/2023] Open
Abstract
Background Human immunodeficiency virus (HIV) and herpes simplex virus type 2 (HSV2) are strongly associated, although mechanisms are not fully understood. An HIV prevention trial allowed reexamination of this association at individual and community levels. Methods The HIV Prevention Trials Network 071 (PopART) study evaluates a combination prevention intervention in 21 urban communities in Zambia and South Africa. To measure impact on HIV infection incidence, a cohort of approximately 2000 adults (age range, 18-44 years) was selected randomly from each community. Baseline data on sociodemographic characteristics, behavior, and HIV/HSV2 serologic findings were used to examine the association between HIV and HSV2. At the community level, HIV prevalence was plotted against HSV2 prevalence. Results A total of 38691 adults participated. HSV2 prevalence among women and men was 50% and 22%, respectively, in Zambia and 60% and 27%, respectively, in South Africa. Estimated HSV2 infection incidence among those aged 18-24 years was 8.06 cases/100 person-years (95% confidence interval [CI], 6.76-9.35) and 1.76 cases/100 person-years (95% CI, 1.30-2.22) among women and men, respectively. A 6-fold higher odds of HIV infection was seen in HSV2-infected individuals in both sexes, after adjustment for confounders (odds ratio, 6.66 [95% CI, 6.07-7.31] among women and 6.57 [95% CI, 5.56-7.77] among men). At the community-level, there was a strong linear relationship between HIV and HSV2 prevalence (ρ = 0.92; P < .001). Conclusions There was an exquisite association between these 2 infections, at the individual and community levels, likely due in part to a powerful cofactor effect of HSV2 on HIV transmission. HSV2 control could contribute to HIV prevention.
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Affiliation(s)
| | - Sian Floyd
- MRC Tropical Epidemiology Group, United Kingdom
| | - Estelle Piwowar-Manning
- HIV Prevention Trials Network Laboratory Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oliver Laeyendecker
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland
| | - Alicia Young
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Nomtha Bell-Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa
| | - Justin Bwalya
- Zambart, University of Zambia School of Medicine, Lusaka
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa
| | - Sarah Fidler
- HIV Clinical Trials Unit, Department of Medicine Imperial College London, United Kingdom
| | - Helen Ayles
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, United Kingdom.,Zambart, University of Zambia School of Medicine, Lusaka
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13
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Hasan M, Islam S, Chakraborty S, Mustafa AH, Azim KF, Joy ZF, Hossain MN, Foysal SH, Hasan MN. Contriving a chimeric polyvalent vaccine to prevent infections caused by herpes simplex virus (type-1 and type-2): an exploratory immunoinformatic approach. J Biomol Struct Dyn 2019; 38:2898-2915. [PMID: 31328668 DOI: 10.1080/07391102.2019.1647286] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Herpes simplex virus type 1 (HSV-1) and 2 (HSV-2) cause a variety of infections including oral-facial infections, genital herpes, herpes keratitis, cutaneous infection and so on. To date, FDA-approved licensed HSV vaccine is not available yet. Hence, the study was conducted to identify and characterize an effective epitope based polyvalent vaccine against both types of Herpes Simplex Virus. The selected proteins were retrieved from ViralZone and assessed to design highly antigenic epitopes by binding analyses of the peptides with MHC class-I and class-II molecules, antigenicity screening, transmembrane topology screening, allergenicity and toxicity assessment, population coverage analysis and molecular docking approach. The final vaccine was constructed by the combination of top CTL, HTL and BCL epitopes from each protein along with suitable adjuvant and linkers. Physicochemical and secondary structure analysis, disulfide engineering, molecular dynamic simulation and codon adaptation were further employed to develop a unique multi-epitope peptide vaccine. Docking analysis of the refined vaccine structure with different MHC molecules and human immune TLR-2 receptor demonstrated higher interaction. Complexed structure of the modeled vaccine and TLR-2 showed minimal deformability at molecular level. Moreover, translational potency and microbial expression of the modeled vaccine was analyzed with pET28a(+) vector for E. coli strain K12 and the vaccine constructs had no similarity with entire human proteome. The study enabled design of a novel chimeric polyvalent vaccine to confer broad range immunity against both HSV serotypes. However, further wet lab based research using model animals are highly recommended to experimentally validate our findings.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Mahmudul Hasan
- Faculty of Biotechnology and Genetic Engineering, Sylhet Agricultural University, Sylhet, Bangladesh.,Department of Pharmaceuticals and Industrial Biotechnology, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Shiful Islam
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Sourav Chakraborty
- Department of Genetic Engineering and Biotechnology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Abu Hasnat Mustafa
- Department of Genetic Engineering and Biotechnology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Kazi Faizul Azim
- Faculty of Biotechnology and Genetic Engineering, Sylhet Agricultural University, Sylhet, Bangladesh.,Department of Microbial Biotechnology, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Ziaul Faruque Joy
- Department of Genetic Engineering and Biotechnology, Shahjalal University of Science and Technology, Sylhet, Bangladesh.,Department of Biomedical Science, University of Sheffield, Sheffield, UK
| | - Md Nazmul Hossain
- Faculty of Biotechnology and Genetic Engineering, Sylhet Agricultural University, Sylhet, Bangladesh.,Department of Microbial Biotechnology, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Shakhawat Hossain Foysal
- Department of Genetic Engineering and Biotechnology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Md Nazmul Hasan
- Department of Genetic Engineering and Biotechnology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
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14
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An analysis of the development assistance for health (DAH) allocations for STD control in Africa. HEALTH ECONOMICS POLICY AND LAW 2019; 15:458-476. [PMID: 30968812 DOI: 10.1017/s1744133119000197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Sustainable Development Goals set by the United Nations recognize the importance of making progress in the eradication and treatment of sexually transmitted deceases (STD). STD are among the most widespread diseases in the world and have the highest prevalence in Sub-Saharan Africa. The current study explored the associations between the allocation of the development assistance for health (DAH) in 54 African countries and key development indicators - STD incidence, Gross Domestic Product per capita, health expenditure, and life expectancy at birth. It employed descriptive statistical methods, the matrix scatter plot analysis and the Pearson correlation test for this purpose. The findings indicated that there was a considerable increase in the volume of the DAH given to control and prevent STD in Africa over the period of 2002-2011. A statistically significant positive association was detected between the STD incidence and the health aid allocations. At the same time, the imbalance in the distribution of the health aid between the major and minor aid recipients in the continent increased. The study concludes by discussing policy implications that can be drawn from these findings.
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15
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Abstract
Biological sex is a determinant of both susceptibility to and pathogenesis of multiple infections, including HIV. These differences have effects on the spectrum of HIV disease from acquisition to eradication, with diverse mechanisms including distinct chromosomal complements, variation in microbiota composition, hormonal effects on transcriptional profiles, and expression of different immunoregulatory elements. With a comparative biology approach, these sex differences can be used to highlight protective and detrimental immune activation pathways, to identify strategies for effective prevention, treatment, and curative interventions.
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Affiliation(s)
- Eileen P Scully
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine
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16
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Abstract
PURPOSE OF REVIEW This review will outline the multilevel effects of biological sex on HIV acquisition, pathogenesis, treatment response, and prospects for cure. Potential mechanisms will be discussed along with future research directions. RECENT FINDINGS HIV acquisition risk is modified by sex hormones and the vaginal microbiome, with the latter acting through both inflammation and local metabolism of pre-exposure prophylaxis drugs. Female sex associates with enhanced risk for non-AIDS morbidities including cardiovascular and cerebrovascular disease, suggesting different inflammatory profiles in men and women. Data from research on HIV cure points to sex differences in viral reservoir dynamics and a direct role for sex hormones in latency maintenance. Biological sex remains an important variable in determining the risk of HIV infection and subsequent viral pathogenesis, and emerging data suggest sex differences relevant to curative interventions. Recruitment of women in HIV clinical research is a pathway to both optimize care for women and to identify novel therapeutics for use in both men and women.
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Affiliation(s)
- Eileen P Scully
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Pre-Clinical Teaching Building, Suite 211, 725 N Wolfe Street, Baltimore, MD, 21205, USA.
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17
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Hofmeyr GJ, Morrison CS, Baeten JM, Chipato T, Donnell D, Gichangi P, Mugo N, Nanda K, Rees H, Steyn P, Taylor D. Rationale and design of a multi-center, open-label, randomised clinical trial comparing HIV incidence and contraceptive benefits in women using three commonly-used contraceptive methods (the ECHO study). Gates Open Res 2018; 1:17. [PMID: 29355224 PMCID: PMC5771152 DOI: 10.12688/gatesopenres.12775.2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2018] [Indexed: 11/20/2022] Open
Abstract
Background:In vitro, animal, biological and observational clinical studies suggest that some hormonal methods, particularly depot medroxyprogesterone acetate - DMPA, may increase women's risk of HIV acquisition. DMPA is the most common contraceptive used in many countries worst affected by the HIV epidemic. To provide robust evidence for contraceptive decision-making among women, clinicians and planners, we are conducting the Evidence for Contraceptive Options and HIV Outcomes (ECHO) study in four countries with high HIV incidence and DMPA use: Kenya, South Africa, Swaziland, and Zambia (Clinical Trials.gov identifier NCT02550067). Study design: We randomized HIV negative, sexually active women 16-35 years old requesting effective contraception and agreeing to participate to either DMPA, the copper T 380A intrauterine device or levonorgestrel implant. Participants attend a contraception support visit after 1 month and quarterly visits thereafter for up to 18 months. Participants receive a standard HIV prevention package and contraceptive side-effect management at each visit. The primary outcome is HIV seroconversion. Secondary outcomes include pregnancy, serious adverse events and method discontinuation. The sample size of 7800 women provides 80% power to detect a 50% relative increase in HIV risk between any of the three method pairs, assuming 250 incident infections per comparison. Ethical considerations: Several WHO consultations have concluded that current evidence on HIV risk associated with DMPA is inconclusive and that a randomized trial is needed to guide policy, counselling and choice. Previous studies suggest that women without a specific contraceptive preference are willing to accept randomization to different contraceptive methods. Stringent performance standards are monitored by an independent data and safety monitoring board approximately every 6 months. The study has been conducted with extensive stakeholder engagement. Conclusions: The ECHO study is designed to provide robust evidence on the relative risks (HIV acquisition) and benefits (pregnancy prevention) between three effective contraceptive methods.
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Affiliation(s)
- G. Justus Hofmeyr
- Effective Care Research Unit, Universities of Witwatersrand and Fort Hare, Eastern Cape Department of Health, East London, South Africa
| | | | - Jared M. Baeten
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Tsungai Chipato
- Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe
| | - Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Peter Gichangi
- University of Nairobi, Nairobi, Kenya
- Ghent University, Ghent, Belgium
- International Centre for Reproductive Health (ICRH), Mombasa, Kenya
| | - Nelly Mugo
- Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kavita Nanda
- Global Health, Population and Nutrition, FHI 360, Durham, NC, USA
| | - Helen Rees
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Douglas Taylor
- Global Health, Population and Nutrition, FHI 360, Durham, NC, USA
| | - ECHO Trial Team
- Effective Care Research Unit, Universities of Witwatersrand and Fort Hare, Eastern Cape Department of Health, East London, South Africa
- Global Health, Population and Nutrition, FHI 360, Durham, NC, USA
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
- Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Nairobi, Nairobi, Kenya
- Ghent University, Ghent, Belgium
- International Centre for Reproductive Health (ICRH), Mombasa, Kenya
- Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
- World Health Organization, Geneva, Switzerland
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18
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Hofmeyr GJ, Morrison CS, Baeten JM, Chipato T, Donnell D, Gichangi P, Mugo N, Nanda K, Rees H, Steyn P, Taylor D. Rationale and design of a multi-center, open-label, randomised clinical trial comparing HIV incidence and contraceptive benefits in women using three commonly-used contraceptive methods (the ECHO study). Gates Open Res 2017; 1:17. [PMID: 29355224 PMCID: PMC5771152 DOI: 10.12688/gatesopenres.12775.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In vitro, animal, biological and observational clinical studies suggest that some hormonal methods, particularly depot medroxyprogesterone acetate - DMPA, may increase women's risk of HIV acquisition. DMPA is the most common contraceptive used in many countries worst affected by the HIV epidemic. To provide robust evidence for contraceptive decision-making among women, clinicians and planners, we are conducting the Evidence for Contraceptive Options and HIV Outcomes (ECHO) study in four countries with high HIV incidence and DMPA use: Kenya, South Africa, Swaziland, and Zambia (Clinical Trials.gov identifier NCT02550067). STUDY DESIGN We randomized HIV negative, sexually active women 16-35 years old requesting effective contraception and agreeing to participate to either DMPA, the copper T 380A intrauterine device or levonorgestrel implant. Participants attend a contraception support visit after 1 month and quarterly visits thereafter for 12 to 18 months. Participants receive a standard HIV prevention package and contraceptive side-effect management at each visit. The primary outcome is HIV seroconversion. Secondary outcomes include pregnancy, serious adverse events and method discontinuation. The sample size of 7800 women provides 80% power to detect a 50% difference in HIV risk between any of the three method pairs, assuming 250 incident infections per comparison. Ethical considerations: Several WHO consultations have concluded that current evidence on HIV risk associated with DMPA is inconclusive and that a randomized trial is needed to guide policy, counselling and choice. Previous studies suggest that women without a specific contraceptive preference are willing to accept randomization to different contraceptive methods. Stringent performance standards are monitored by an independent data and safety monitoring board approximately every 6 months. The study has been conducted with extensive stakeholder engagement. CONCLUSIONS The ECHO study is designed to provide robust evidence on the relative risks (HIV acquisition) and benefits (pregnancy prevention) between three effective contraceptive methods.
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Affiliation(s)
- G. Justus Hofmeyr
- Effective Care Research Unit, Universities of Witwatersrand and Fort Hare, Eastern Cape Department of Health, East London, South Africa
| | | | - Jared M. Baeten
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Tsungai Chipato
- Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe
| | - Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Peter Gichangi
- University of Nairobi, Nairobi, Kenya
- Ghent University, Ghent, Belgium
- International Centre for Reproductive Health (ICRH), Mombasa, Kenya
| | - Nelly Mugo
- Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kavita Nanda
- Global Health, Population and Nutrition, FHI 360, Durham, NC, USA
| | - Helen Rees
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Douglas Taylor
- Global Health, Population and Nutrition, FHI 360, Durham, NC, USA
| | - ECHO Trial Team
- Effective Care Research Unit, Universities of Witwatersrand and Fort Hare, Eastern Cape Department of Health, East London, South Africa
- Global Health, Population and Nutrition, FHI 360, Durham, NC, USA
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
- Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Nairobi, Nairobi, Kenya
- Ghent University, Ghent, Belgium
- International Centre for Reproductive Health (ICRH), Mombasa, Kenya
- Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
- World Health Organization, Geneva, Switzerland
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19
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Looker KJ, Elmes JAR, Gottlieb SL, Schiffer JT, Vickerman P, Turner KME, Boily MC. Effect of HSV-2 infection on subsequent HIV acquisition: an updated systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2017; 17:1303-1316. [PMID: 28843576 PMCID: PMC5700807 DOI: 10.1016/s1473-3099(17)30405-x] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/13/2017] [Accepted: 06/27/2017] [Indexed: 11/17/2022]
Abstract
Background 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. Methods 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. Findings 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). Interpretation 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. Funding World Health Organization.
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Affiliation(s)
- Katharine J Looker
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
| | - Jocelyn A R Elmes
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Sami L Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Joshua T Schiffer
- Vaccine and Infectious Disease Division, and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Sex and gender differences in HIV-1 infection. Clin Sci (Lond) 2017; 130:1435-51. [PMID: 27389589 DOI: 10.1042/cs20160112] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/06/2016] [Indexed: 01/03/2023]
Abstract
The major burden of the human immunodeficiency (HIV) type 1 pandemic is nowadays carried by women from sub-Saharan Africa. Differences in the manifestations of HIV-1 infection between women and men have been long reported, and might be due to both socio-economic (gender) and biological (sex) factors. Several studies have shown that women are more susceptible to HIV-1 acquisition than men. Following HIV-1 infection, women have lower viral loads during acute infection and exhibit stronger antiviral responses than men, which may contribute to differences in the size of viral reservoirs. Oestrogen receptor signalling could represent an important mediator of sex differences in HIV-1 reservoir size and may represent a potential therapeutic target. Furthermore, immune activation, a hallmark of HIV-1 infection, is generally higher in women than in men and could be a central mechanism in the sex difference observed in the speed of HIV-1 disease progression. Here, we review the literature regarding sex-based differences in HIV-1 infection and discuss how a better understanding of the underlying mechanisms could improve preventive and therapeutic strategies.
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21
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Finger-Jardim F, Avila EC, da Hora VP, Gonçalves CV, de Martinez AMB, Soares MA. Prevalence of herpes simplex virus types 1 and 2 at maternal and fetal sides of the placenta in asymptomatic pregnant women. Am J Reprod Immunol 2017; 78. [PMID: 28440579 DOI: 10.1111/aji.12689] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/20/2017] [Indexed: 12/30/2022] Open
Abstract
PROBLEM Herpes simplex virus 1 (HSV-1) commonly causes orolabial infection, but can also infect the genital mucosa. In contrast, HSV-2 is usually genital. Genital herpes can transmit the virus vertically to the fetus during pregnancy. We sought to estimate the prevalence of HSV-1/2 on the maternal and fetal sides of the placenta. METHOD OF STUDY Placental tissues were collected from pregnant women seen at the Rio Grande University Hospital. HSV-1 and HSV-2 were detected by nested PCR. RESULTS The prevalence of HSV-1 and HSV-2 was, respectively, 28% and 12.6% (maternal side) and 29.9% and 8.3% (fetal side). All HSV-positive women were asymptomatic. Sexual behavior, vaginal delivery, and presence of HSVs on one side of the placenta were risk factors associated with HSV infection. CONCLUSION The occurrence of HSVs in placental tissue was high, especially for HSV-1. Novel strategies need to be implemented for the management of asymptomatic women who might transmit HSV to their newborns.
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Affiliation(s)
- Fabiana Finger-Jardim
- Molecular Biology Laboratory, School of Medicine, Universidade Federal do Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Emiliana C Avila
- Molecular Biology Laboratory, School of Medicine, Universidade Federal do Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Vanusa P da Hora
- Molecular Biology Laboratory, School of Medicine, Universidade Federal do Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Carla V Gonçalves
- Center for Obstetrics and Gynecology, School of Medicine, Universidade Federal do Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Ana Maria B de Martinez
- Molecular Biology Laboratory, School of Medicine, Universidade Federal do Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Marcelo A Soares
- Oncovirology Program, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Rio de Janeiro, Brazil
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22
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Socías ME, Duff P, Shoveller J, Montaner JSG, Nguyen P, Ogilvie G, Shannon K. Use of injectable hormonal contraception and HSV-2 acquisition in a cohort of female sex workers in Vancouver, Canada. Sex Transm Infect 2016; 93:284-289. [PMID: 27821613 DOI: 10.1136/sextrans-2016-052838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/22/2016] [Accepted: 10/15/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Increased risk of herpes simplex virus 2 (HSV-2) has been proposed as a possible indirect pathway through which hormonal contraceptives (specifically depot medroxyprogesterone acetate (DMPA)) may increase the risk of HIV acquisition among women. We investigated the effects of DMPA on HSV-2 acquisition among female sex workers. METHODS Longitudinal data were drawn from a prospective cohort of sex workers in Vancouver, Canada. The primary outcome was HSV-2 seroconversion. Extended Cox regression analyses were used to model the independent effect of DMPA use on HSV-2 acquisition. RESULTS Between January 2010 and February 2014, 149 HSV-2 seronegative women were enrolled, contributing to 228 person-years (py) of follow-up. Of these, 19 (13.3%) reported DMPA use. There were 39 HSV-2 seroconversions (12 among DMPA users and 27 among non-users) over the study period (median follow-up of 18.6 months (IQR 8.4-29.9)), resulting in an overall incidence rate of 17.1 cases per 100 py (95% CI 12.4 to 23.6). Incidence rates were higher among DMPA users (57.4 cases per 100 py, 95% CI 31.4 to 105.0) compared with non-users (13.1 cases per 100 py, 95% CI 8.9 to 19.1). After adjusting for key confounders, use of DMPA remained an independent predictor of HSV-2 acquisition (adjusted HR 4.43, 95% CI 1.90 to 10.35). CONCLUSIONS The high observed incidence rates of HSV-2, together with a strong association between DMPA exposure and HSV-2 acquisition, raise serious concerns about the provision of optimal reproductive and sexual healthcare to sex workers in this setting. Given the known links between HSV-2 and HIV, our findings underscore the need for further research to better understand the potential association between DMPA and increased risk of HSV-2 and other STIs to help inform the development of safer reproductive choices for women worldwide.
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Affiliation(s)
- M Eugenia Socías
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Putu Duff
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jean Shoveller
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Paul Nguyen
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Shannon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Looker KJ, Magaret AS, May MT, Turner KME, Vickerman P, Gottlieb SL, Newman LM. Global and Regional Estimates of Prevalent and Incident Herpes Simplex Virus Type 1 Infections in 2012. PLoS One 2015; 10:e0140765. [PMID: 26510007 PMCID: PMC4624804 DOI: 10.1371/journal.pone.0140765] [Citation(s) in RCA: 385] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/30/2015] [Indexed: 11/23/2022] Open
Abstract
Background Herpes simplex virus type 1 (HSV-1) commonly causes orolabial ulcers, while HSV-2 commonly causes genital ulcers. However, HSV-1 is an increasing cause of genital infection. Previously, the World Health Organization estimated the global burden of HSV-2 for 2003 and for 2012. The global burden of HSV-1 has not been estimated. Methods We fitted a constant-incidence model to pooled HSV-1 prevalence data from literature searches for 6 World Health Organization regions and used 2012 population data to derive global numbers of 0-49-year-olds with prevalent and incident HSV-1 infection. To estimate genital HSV-1, we applied values for the proportion of incident infections that are genital. Findings We estimated that 3709 million people (range: 3440–3878 million) aged 0–49 years had prevalent HSV-1 infection in 2012 (67%), with highest prevalence in Africa, South-East Asia and Western Pacific. Assuming 50% of incident infections among 15-49-year-olds are genital, an estimated 140 million (range: 67–212 million) people had prevalent genital HSV-1 infection, most of which occurred in the Americas, Europe and Western Pacific. Conclusions The global burden of HSV-1 infection is huge. Genital HSV-1 burden can be substantial but varies widely by region. Future control efforts, including development of HSV vaccines, should consider the epidemiology of HSV-1 in addition to HSV-2, and especially the relative contribution of HSV-1 to genital infection.
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Affiliation(s)
- Katharine J. Looker
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Amalia S. Magaret
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
| | - Margaret T. May
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | | | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Sami L. Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Lori M. Newman
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Fichorova RN, Chen PL, Morrison CS, Doncel GF, Mendonca K, Kwok C, Chipato T, Salata R, Mauck C. The Contribution of Cervicovaginal Infections to the Immunomodulatory Effects of Hormonal Contraception. mBio 2015; 6:e00221-15. [PMID: 26330510 PMCID: PMC4556810 DOI: 10.1128/mbio.00221-15] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 07/23/2015] [Indexed: 01/15/2023] Open
Abstract
UNLABELLED Particular types of hormonal contraceptives (HCs) and genital tract infections have been independently associated with risk of HIV-1 acquisition. We examined whether immunity in women using injectable depot medroxyprogesterone acetate (DMPA), combined oral contraceptives (COC), or no HCs differs by the presence of cervicovaginal infections. Immune mediators were quantified in cervical swabs from 832 HIV-uninfected reproductive-age Ugandans and Zimbabweans. Bacterial infections and HIV were diagnosed by PCR, genital herpes serostatus by enzyme-linked immunosorbent assay (ELISA), altered microflora by Nugent score, and Trichomonas vaginalis and Candida albicans infection by wet mount. Generalized linear models utilizing Box-Cox-Power transformation examined associations between levels of mediators, infection status, and HCs. In no-HC users, T. vaginalis was associated with broadest spectrum of aberrant immunity (higher interleukin 1β [IL-1β], IL-8, macrophage inflammatory protein 3α [MIP-3α], β-defensin 2 [BD2], and IL-1 receptor antigen [IL-1RA]). In women with a normal Nugent score and no genital infection, compared to the no-HC group, COC users showed higher levels of IL-1β, IL-6, IL-8, and IL-1RA, while DMPA users showed higher levels of RANTES and lower levels of BD2, both associated with HIV seroconversion. These effects of COC were blunted in the presence of gonorrhea, chlamydia, trichomoniasis, candidiasis, and an abnormal Nugent score; however, RANTES was increased among COC users with herpes, chlamydia, and abnormal Nugent scores. The effect of DMPA was exacerbated by lower levels of IL-1RA in gonorrhea, chlamydia, or herpes, SLPI in gonorrhea, and IL-1β, MIP-3α, and IL-1RA/IL1β ratio in trichomoniasis. Thus, the effects of HC on cervical immunity depend on the genital tract microenvironment, and a weakened mucosal barrier against HIV may be a combined resultant of genital tract infections and HC use. IMPORTANCE In this article, we show that in young reproductive-age women most vulnerable to HIV, hormonal contraceptives are associated with altered cervical immunity in a manner dependent on the presence of genital tract infections. Through altered immunity, hormones may predispose women to bacterial and viral pathogens; conversely, a preexisting specific infection or disturbed vaginal microbiota may suppress the immune activation by levonorgestrel or exacerbate the suppressed immunity by DMPA, thus increasing HIV risk by their cumulative action. Clinical studies assessing the effects of contraception on HIV susceptibility and mucosal immunity may generate disparate results in populations that differ by microbiota background or prevalence of undiagnosed genital tract infections. A high prevalence of asymptomatic infections among HC users that remain undiagnosed and untreated raises even more concerns in light of their combined effects on biomarkers of HIV risk. The molecular mechanisms of the vaginal microbiome's simultaneous interactions with hormones and HIV remain to be elucidated.
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Affiliation(s)
- Raina N Fichorova
- Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Kevin Mendonca
- Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Robert Salata
- Case Western Reserve University, Cleveland, Ohio, USA
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Ding Y, Wu Z, Duan S, Rou K, Yang Y, Wang J, Gao M, Ye R, Detels R, He N. Risk factors for incident HSV-2 infections among a prospective cohort of HIV-1-discordant couples in China. Sex Transm Infect 2015; 92:76-82. [PMID: 26139205 DOI: 10.1136/sextrans-2014-051975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 06/13/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Identification of risk factors is essential for developing herpes simplex virus type 2 (HSV-2) prevention interventions that could also reduce HIV-1 transmission, particularly among HIV-1-discordant couples. METHODS A prospective cohort study was conducted among HIV-1-discordant couples from June 2009 to March 2011 in Yunnan province, China. 413 HIV-1-infected partners and 517 HIV-1-uninfected partners who were HSV-2 seronegative or equivocal at enrolment and who had a study partner completing the baseline survey and HSV-2 testing were included in the analysis. RESULTS HSV-2 incidence was 2.9 per 100 person-years (PY) for HIV-1-infected partners and 4.5 per 100 PY for HIV-1-uninfected partners. At least 36% of incident HSV-2 infections were from outside sexual partner. Among HIV-1-infected partners, multivariate analysis indicated that HSV-2 incidence was significantly higher among those with baseline equivocal HSV-2 result, having an initially HSV-2 seropositive or equivocal partner, reporting no sex with study partner and initiating antiretroviral therapy (ART) during follow-up. Among HIV-1-uninfected partners, multivariate analysis indicated that HSV-2 incidence was significantly higher among those having an initially HSV-2 seropositive partner and reporting sex with study partner ≥5 times/month, but was lower among those having a partner with baseline CD4(+) count ≥350 cells/μL. CONCLUSIONS Our findings underscore the importance of developing prevention and intervention programmes to reduce HSV-2 transmission among this population. The relationship between ART initiation and HSV-2 seroconversion requires further investigation.
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Affiliation(s)
- Yingying Ding
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Song Duan
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Keming Rou
- National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Yuecheng Yang
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Jibao Wang
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Meiyang Gao
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Runhua Ye
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Roger Detels
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, Los Angeles, USA
| | - Na He
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
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Stanfield B, Kousoulas KG. Herpes Simplex Vaccines: Prospects of Live-attenuated HSV Vaccines to Combat Genital and Ocular infections. CURRENT CLINICAL MICROBIOLOGY REPORTS 2015; 2:125-136. [PMID: 27114893 DOI: 10.1007/s40588-015-0020-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Herpes simplex virus type-1 (HSV-1) and its closely related type-2 (HSV-2) viruses cause important clinical manifestations in humans including acute ocular disease and genital infections. These viruses establish latency in the trigeminal ganglionic and dorsal root neurons, respectively. Both viruses are widespread among humans and can frequently reactivate from latency causing disease. Currently, there are no vaccines available against herpes simplex viral infections. However, a number of promising vaccine approaches are being explored in pre-clinical investigations with few progressing to early phase clinical trials. Consensus research findings suggest that robust humoral and cellular immune responses may partially control the frequency of reactivation episodes and reduce clinical symptoms. Live-attenuated viral vaccines have long been considered as a viable option for generating robust and protective immune responses against viral pathogens. Varicella zoster virus (VZV) belongs to the same alphaherpesvirus subfamily with herpes simplex viruses. A live-attenuated VZV vaccine has been extensively used in a prophylactic and therapeutic approach to combat primary and recurrent VZV infection indicating that a similar vaccine approach may be feasible for HSVs. In this review, we summarize pre-clinical approaches to HSV vaccine development and current efforts to test certain vaccine approaches in human clinical trials. Also, we discuss the potential advantages of using a safe, live-attenuated HSV-1 vaccine strain to protect against both HSV-1 and HSV-2 infections.
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Affiliation(s)
- Brent Stanfield
- Division of Biotechnology & Molecular Medicine, Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Konstantin Gus Kousoulas
- Division of Biotechnology & Molecular Medicine, Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA
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Ugaonkar SR, Wesenberg A, Wilk J, Seidor S, Mizenina O, Kizima L, Rodriguez A, Zhang S, Levendosky K, Kenney J, Aravantinou M, Derby N, Grasperge B, Gettie A, Blanchard J, Kumar N, Roberts K, Robbiani M, Fernández-Romero JA, Zydowsky TM. A novel intravaginal ring to prevent HIV-1, HSV-2, HPV, and unintended pregnancy. J Control Release 2015; 213:57-68. [PMID: 26091920 DOI: 10.1016/j.jconrel.2015.06.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/02/2015] [Accepted: 06/14/2015] [Indexed: 12/12/2022]
Abstract
Women urgently need a self-initiated, multipurpose prevention technology (MPT) that simultaneously reduces their risk of acquiring HIV-1, HSV-2, and HPV (latter two associated with increased risk of HIV-1 acquisition) and prevents unintended pregnancy. Here, we describe a novel core-matrix intravaginal ring (IVR), the MZCL IVR, which effectively delivered the MZC combination microbicide and a contraceptive. The MZCL IVR contains four active pharmaceutical ingredients (APIs): MIV-150 (targets HIV-1), zinc acetate (ZA; targets HIV-1 and HSV-2), carrageenan (CG; targets HPV and HSV-2), and levonorgestrel (LNG; targets unintended pregnancy). The elastomeric IVR body (matrix) was produced by hot melt extrusion of the non-water swellable elastomer, ethylene vinyl acetate (EVA-28), containing the hydrophobic small molecules, MIV-150 and LNG. The solid hydrophilic core, embedded within the IVR by compression, contained the small molecule ZA and the macromolecule CG. Hydrated ZA/CG from the core was released by diffusion via a pore on the IVR while the MIV-150/LNG diffused from the matrix continuously for 94 days (d) in vitro and up to 28 d (study period) in macaques. The APIs released in vitro and in vivo were active against HIV-1ADA-M, HSV-2, and HPV16 PsV in cell-based assays. Serum LNG was at levels associated with local contraceptive effects. The results demonstrate proof-of-concept of a novel core-matrix IVR for sustained and simultaneous delivery of diverse molecules for the prevention of HIV, HSV-2 and HPV acquisition, as well as unintended pregnancy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Brooke Grasperge
- Tulane National Primate Research Center, Tulane University, Covington, LA 70433, USA
| | - Agegnehu Gettie
- Aaron Diamond AIDS Research Center, Rockefeller University, NY 10065, USA
| | - James Blanchard
- Tulane National Primate Research Center, Tulane University, Covington, LA 70433, USA
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Looker KJ, Magaret AS, Turner KME, Vickerman P, Gottlieb SL, Newman LM. Global estimates of prevalent and incident herpes simplex virus type 2 infections in 2012. PLoS One 2015; 10:e114989. [PMID: 25608026 PMCID: PMC4301914 DOI: 10.1371/journal.pone.0114989] [Citation(s) in RCA: 306] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/17/2014] [Indexed: 01/16/2023] Open
Abstract
Background Herpes simplex virus type 2 (HSV-2) infection causes significant disease globally. Adolescent and adult infection may present as painful genital ulcers. Neonatal infection has high morbidity and mortality. Additionally, HSV-2 likely contributes substantially to the spread of HIV infection. The global burden of HSV-2 infection was last estimated for 2003. Here we present new global estimates for 2012 of the burden of prevalent (existing) and incident (new) HSV-2 infection among females and males aged 15–49 years, using updated methodology to adjust for test performance and estimate by World Health Organization (WHO) region. Methods and Findings We conducted a literature review of HSV-2 prevalence studies world-wide since 2000. We then fitted a model with constant HSV-2 incidence by age to pooled HSV-2 prevalence values by age and sex. Prevalence values were adjusted for test sensitivity and specificity. The model estimated prevalence and incidence by sex for each WHO region to obtain global burden estimates. Uncertainty bounds were computed by refitting the model to reflect the variation in the underlying prevalence data. In 2012, we estimate that there were 417 million people aged 15–49 years (range: 274–678 million) living with HSV-2 infection world-wide (11.3% global prevalence), of whom 267 million were women. We also estimate that in 2012, 19.2 million (range: 13.0–28.6 million) individuals aged 15–49 years were newly-infected (0.5% of all individuals globally). The highest burden was in Africa. However, despite lower prevalence, South-East Asia and Western Pacific regions also contributed large numbers to the global totals because of large population sizes. Conclusions The global burden of HSV-2 infection is large, leaving over 400 million people at increased risk of genital ulcer disease, HIV acquisition, and transmission of HSV-2 to partners or neonates. These estimates highlight the critical need for development of vaccines, microbicides, and other new HSV prevention strategies.
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Affiliation(s)
- Katharine J. Looker
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Amalia S. Magaret
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
| | | | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Sami L. Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Lori M. Newman
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Roth AM, Van Der Pol B, Fortenberry JD, Dodge B, Reece M, Certo D, Zimet GD. The impact of brief messages on HSV-2 screening uptake among female defendants in a court setting: a randomized controlled trial utilizing prospect theory. JOURNAL OF HEALTH COMMUNICATION 2014; 20:230-6. [PMID: 25494832 PMCID: PMC4356496 DOI: 10.1080/10810730.2014.920062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Epidemiologic data demonstrate that women involved with the criminal justice system in the United States are at high risk for sexually transmitted infections, including herpes simplex virus type 2 (HSV-2). Female defendants were recruited from a misdemeanor court to assess whether brief framed messages utilizing prospect theory could encourage testing for HSV-2. Participants were randomly assigned to a message condition (gain, loss, or control), completed an interviewer-administered survey assessing factors associated with antibody test uptake/refusal and were offered free point-of-care HSV-2 serologic testing. Although individuals in the loss-frame group accepted testing at the highest rate, an overall statistical difference in HSV-2 testing behavior by group (p ≤ .43) was not detected. The majority of the sample (74.6%) characterized receiving a serological test for HSV-2 as health affirming. However, this did not moderate the effect of the intervention nor was it significantly associated with test acceptance (p ≤ .82). Although the effects of message framing are subtle, the findings have important theoretical implications given the participants' characterization of HSV-2 screening as health affirming despite being a detection behavior. Implications of study results for health care providers interested in brief, low cost interventions are also explored.
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Affiliation(s)
- Alexis M Roth
- a School of Public Health , Drexel University , Philadelphia , Pennsylvania , USA
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Stanfield BA, Stahl J, Chouljenko VN, Subramanian R, Charles AS, Saied AA, Walker JD, Kousoulas KG. A single intramuscular vaccination of mice with the HSV-1 VC2 virus with mutations in the glycoprotein K and the membrane protein UL20 confers full protection against lethal intravaginal challenge with virulent HSV-1 and HSV-2 strains. PLoS One 2014; 9:e109890. [PMID: 25350288 PMCID: PMC4211657 DOI: 10.1371/journal.pone.0109890] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/11/2014] [Indexed: 01/01/2023] Open
Abstract
Herpes Simplex Virus type-1 (HSV-1) and type-2 (HSV-2) establish life-long infections and cause significant orofacial and genital infections in humans. HSV-1 is the leading cause of infectious blindness in the western world. Currently, there are no available vaccines to protect against herpes simplex infections. Recently, we showed that a single intramuscular immunization with an HSV-1(F) mutant virus lacking expression of the viral glycoprotein K (gK), which prevents the virus from entering into distal axons of ganglionic neurons, conferred significant protection against either virulent HSV-1(McKrae) or HSV-2(G) intravaginal challenge in mice. Specifically, 90% of the mice were protected against HSV-1(McKrae) challenge, while 70% of the mice were protected against HSV-2(G) challenge. We constructed the recombinant virus VC2 that contains specific mutations in gK and the membrane protein UL20 preventing virus entry into axonal compartments of neurons, while allowing efficient replication in cell culture, unlike the gK-null virus, which has a major defect in virus replication and spread. Intramuscular injection of mice with 107 VC2 plaque forming units did not cause any significant clinical disease in mice. A single intramuscular immunization with the VC2 virus protected 100% of mice against lethal intravaginal challenge with either HSV-1(McKrae) or HSV-2(G) viruses. Importantly, vaccination with VC2 produced robust cross protective humoral and cellular immunity that fully protected vaccinated mice against lethal disease. Quantitative PCR did not detect any viral DNA in ganglionic tissues of vaccinated mice, while unvaccinated mice contained high levels of viral DNA. The VC2 virus may serve as an efficient vaccine against both HSV-1 and HSV-2 infections, as well as a safe vector for the production of vaccines against other viral and bacterial pathogens.
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Affiliation(s)
- Brent A. Stanfield
- Division of Biotechnology & Molecular Medicine and Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Jacque Stahl
- Division of Biotechnology & Molecular Medicine and Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Vladimir N. Chouljenko
- Division of Biotechnology & Molecular Medicine and Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Ramesh Subramanian
- Division of Biotechnology & Molecular Medicine and Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Anu-Susan Charles
- Division of Biotechnology & Molecular Medicine and Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Ahmad A. Saied
- Division of Biotechnology & Molecular Medicine and Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Jason D. Walker
- Division of Biotechnology & Molecular Medicine and Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Konstantin G. Kousoulas
- Division of Biotechnology & Molecular Medicine and Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
- * E-mail:
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Rajagopal S, Magaret A, Mugo N, Wald A. Incidence of herpes simplex virus type 2 infections in Africa: a systematic review. Open Forum Infect Dis 2014; 1:ofu043. [PMID: 25734115 PMCID: PMC4281803 DOI: 10.1093/ofid/ofu043] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 11/12/2022] Open
Abstract
The burden of HSV type 2 varies substantially by region, with the highest incidence and prevalence in sub-Saharan Africa. We undertook a systematic review to identify studies reporting prospective data on incidence rates in men and women in Africa. Of 18 eligible studies, 7 were conducted in high-risk populations. Among women, incidence rates appeared to be higher in those with high-risk sexual behavior, with rates ranging from 3 to 23 per 100 person-years. In contrast, incidence rates in men appeared to be lower, ranging from 1 to 12 per 100 person-years. Risk factors for HSV-2 in women included prevalent human immunodeficiency virus (HIV) infection, younger age at sexual initiation, and sexual activity. Among men, condom use and circumcision had a protective effect, whereas prevalent HIV increased the risk of HSV-2 acquisition. This review draws attention to the high HSV-2 acquisition rates reported in Africa, thereby identifying an efficient setting for preventative HSV-2 vaccine trials.
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Affiliation(s)
| | - Amalia Magaret
- Laboratory Medicine ; Biostatistics ; Vaccine and Infectious Disease Division , Fred Hutchinson Cancer Research Center , Seattle, Washington
| | - Nelly Mugo
- Departments of Global Health ; Medicine , University of Washington , Seattle, Washington ; Department of Obstetrics and Gynaecology , University of Nairobi , Kenya ; Department of Obstetrics and Gynaecology , Kenyatta National Hospital , Nairobi , Kenya
| | - Anna Wald
- Departments of Epidemiology ; Laboratory Medicine ; Vaccine and Infectious Disease Division , Fred Hutchinson Cancer Research Center , Seattle, Washington ; Medicine , University of Washington , Seattle, Washington
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Al-Shobaili H, Hassanein KM, Mostafa MS, Al Duways AS. Evaluation of the HerpeSelect Express rapid test in the detection of herpes simplex virus type 2 antibodies in patients with genital ulcer disease. J Clin Lab Anal 2014; 29:43-6. [PMID: 24687953 DOI: 10.1002/jcla.21725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 11/12/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND A rapid point-of-care test with high sensitivity and specificity is required in order to fulfill the need for early detection and screening of Herpes simplex virus type 2 (HSV-2) infection among patients with genital ulcer disease (GUD), for better management and control of virus transmission. METHODS The goal of this study is to evaluate the performance of the commercially available HerpeSelect Express rapid test in comparison with three ELISA assays: HerpeSelect ELISA, Kalon HSV-2 glycoprotein G2 assay, and monoclonal antibody blocking enzyme immunoassay, which was used as the gold standard for the detection of HSV-2 antibodies. RESULTS This study showed high sensitivity (ranging from 82.6 to 100%) and specificity (100%) of the HerpeSelect Express rapid test when compared to the three ELISA assays. The agreement between the HerpeSelect Express rapid test with the three ELISAs ranged from 93.3 to 100%. CONCLUSION The HerpeSelect Express rapid test has adequate sensitivity and specificity for confirming HSV-2 infection in patients with GUD, indicating its suitability for epidemiological studies.
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Affiliation(s)
- Hani Al-Shobaili
- Department of Dermatology, College of Medicine, Qassim University, Buraydah, Kingdom of Saudi Arabia
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Herpes simplex virus type 2 infection in young adult women: risk factors for infection and frequency of viral shedding. Sex Transm Dis 2013; 37:248-52. [PMID: 20216477 DOI: 10.1097/olq.0b013e3181d4f866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Population-based studies suggest that acquisition of herpes simplex virus 2 (HSV 2) is most common between ages 20 and 29, especially in minority women. We examined HSV 2 infection and viral shedding in a cohort of young women. METHODS Women, age 18 to 24 (median 21), who were part of an observational cohort enrolled between ages 14 to 17, had blood obtained for HSV 2 antibody. Intensive diary collections on sexual behavior and genital symptoms and weekly vaginal swabs were obtained at regular intervals. RESULTS HSV 2 antibodies were detected in 43 of 127 participants (33.9%), only 4 of whom were previously known to be positive. Factors associated with a positive test included older age, years of sexual activity, and number of lifetime partners. Testing for HSV 2 DNA by polymerase chain reaction on weekly vaginal swabs from a 13-week sampling period for each HSV 2 antibody positive participant showed 32 of 43 (74.4%) were positive at least once. The positive predictive value of pain for viral shedding was poor. CONCLUSIONS HSV 2 infection is very common among young adult women, but symptomatic genital herpes is not. Shedding of HSV 2 DNA can be detected in most antibody positive persons. Early intervention strategies will be needed to control HSV 2 infection.
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Bacterial vaginosis and risk for Trichomonas vaginalis infection: a longitudinal analysis. Sex Transm Dis 2013; 38:882-6. [PMID: 21844747 DOI: 10.1097/olq.0b013e31821f91a1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bacterial vaginosis (BV) and Trichomonas vaginalis (TV) have been estimated to affect one-quarter to one-third of sexually active women worldwide, and are often found concurrently. Few studies have examined this relationship longitudinally to better understand the direction and temporality of this association. METHODS Between 2005 and 2006, a cohort of 853 young, sexually active women was followed in Mysore, India; participants were interviewed and tested for BV and TV at baseline, and at 3- and 6-month visit. Generalized estimating equations were used to estimate how changes in vaginal flora between consecutive visits-as defined by Nugent diagnostic criteria for BV-were related to the risk of TV infection at the latter visit, adjusted for sociodemographic and behavioral covariates. Treatment was offered to women with TV and/or symptomatic BV. RESULTS After adjustment for covariates, participants with abnormal vaginal flora at 2 consecutive visits had 9 times higher risk of TV (95% CI: 4.1, 20.0) at the latter visit, relative to those with persistently normal flora. An increased risk of TV was also observed for participants whose flora status changed from normal to abnormal (adjusted risk ratio: 7.11, 95% CI: 2.8, 18.2) and from abnormal to normal (adjusted risk ratio: 4.50, 95% CI: 1.7, 11.8). CONCLUSIONS Women experiencing abnormal flora during a 3-month span appear to have significantly increased risk of acquiring TV infection. Women of reproductive age in low-resource settings found to have abnormal vaginal flora should be assessed for TV.
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Roth AM, Van Der Pol B, Fortenberry JD, Reece M, Dodge B, Certo D, Zimet GD. Herpes simplex virus type 2 serological testing at a community court: predictors of test acceptance and seropositivity among female defendants. Int J STD AIDS 2013; 24:169-74. [PMID: 23467289 DOI: 10.1177/0956462412472442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the high prevalence of herpes simplex virus type 2 (HSV-2), testing for asymptomatic infections is uncommon. One population for whom targeted interventions may be prioritized include individuals involved with the correctional system. Here we describe the acceptability of a novel HSV-2 screening program, implemented in a court setting, as a possible intervention for corrections-involved women. Female defendants completed an interviewer administered survey assessing factors associated with uptake/refusal of free point-of-care HSV-2 serologic testing and HSV-2 seropositivity. Participants included 143 women, 18-62 years old (mean 32.85) with diverse ethnicities. The majority (65.7%) accepted testing and 62.4% tested HSV-2 seropositive. Factors independently associated with test acceptance included higher perceived susceptibility to genital herpes infection and not receiving a preventative health screen. Women who were seropositive tended to be older, Black, report having previous STI, and be arrested on a prostitution charge. Findings suggest point-of-care testing in a court setting is acceptable to women and can be implemented to improve case finding of STI.
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Affiliation(s)
- A M Roth
- Divisions of Adolescent Medicine and Infectious Diseases, School of Medicine, Indiana University, Indianapolis, IN
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Ghebremichael M, Habtzgi D, Paintsil E. Deciphering the epidemic synergy of herpes simplex virus type 2 (HSV-2) on human immunodeficiency virus type 1 (HIV-1) infection among women in sub-Saharan Africa. BMC Res Notes 2012; 5:451. [PMID: 22909236 PMCID: PMC3519592 DOI: 10.1186/1756-0500-5-451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 08/17/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Herpes Simplex Virus Type 2 (HSV-2) is highly prevalent in regions disproportionately affected by the human immunodeficiency virus (HIV-1) epidemic. The objective of our study was to identify the risk factors of HSV-2 and HIV-1 infections and to examine the association between the two infections. METHODS The study participants were recruited through a community based cross-sectional study that was conducted from November 2002 to March 2003 in the Moshi urban district of Northern Tanzania. A two-stage sampling design was used in recruiting the study participants. Information on socio-demographics, alcohol use, sexual behaviors, and STIs symptoms were obtained. Blood and urine samples were drawn for testing of HIV-1, HSV-2 and other STIs. RESULTS The prevalence of HSV-2 infection among all study participants was 43%. The prevalence rate of HSV-2 among the HIV-negative and HIV-positive women was 40% and 65%, respectively. We found 2.72 times odds of having HIV-1 in an HSV-2 positive woman than in an HSV-2 negative woman. Furthermore, HIV-1 and HSV-2 shared common high-risk sexual behavior factors such as early onset of sexual debut, and testing positive for other STIs. CONCLUSIONS Our findings suggest that HSV-2 may be both a biological and risk-associated cofactor for HIV-1 acquisition. In resource-limited countries, where both infections are prevalent efforts at symptomatic and diagnostic screening and treatment of HSV-2 should be part of HIV-1 prevention programs.
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Affiliation(s)
- Musie Ghebremichael
- Harvard Medical School and Ragon Institute of MGH, MIT and Harvard, Boston, Massachusetts, USA.
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Abstract
BACKGROUND Genital ulcer disease by virtue of disruption of the mucosal surfaces may enhance HIV acquisition. Genital ulcer disease treatment with resolution of the ulcers may therefore contribute in reducing the sexual acquisition of HIV. OBJECTIVES To determine the effects of treatment of genital ulcer disease on sexual acquisition of HIV. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, LILACS, NLM Gateway, Web of Science, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, and reference lists of relevant publications for eligible studies published between 1980 and August 2011. SELECTION CRITERIA Randomized controlled trials of any treatment intervention aimed at curing genital ulcer disease compared with an alternative treatment, placebo, or no treatment. We included only trials whose unit of randomization was the individual with confirmed genital ulcer. DATA COLLECTION AND ANALYSIS We independently selected studies and extracted data in duplicate; resolving discrepancies by discussion, consensus, and arbitration by third review author. We expressed study results as risk ratios (RR) with 95% confidence intervals (CI). MAIN RESULTS There were three randomized controlled trials that met our inclusion criteria recruited HIV-negative participants with chancroid (two trials with 143 participants) and primary syphilis (one trial with 30 participants). The syphilis study, carried out in the US between 1995 and 1997, randomized participants to receive a single 2.0 g oral dose of azithromycin (11 participants); two 2.0 g oral doses of azithromycin administered six to eight days apart (eight participants); or benzathine penicillin G administered as either 2.4 million units intramuscular injection once or twice seven days apart (11 participants). No participant in the trial seroconverted during 12 months of follow-up. The chancroid trials, conducted in Kenya by 1990, found no significant differences in HIV seroconversion rates during four to 12 weeks of follow-up between 400 and 200 mg single oral doses of fleroxacin (one trial, 45 participants; RR 3.00; 95% CI 0.29 to 30.69), or between 400 mg fleroxacin and 800 mg sulfamethoxazole plus 160 mg trimethoprim (one trial, 98 participants; RR 0.33; 95% CI 0.04 to 3.09). Adverse events reported were mild to moderate in severity, and included Jarisch-Herxheimer reactions and gastrointestinal symptoms. The differences between the treatment arms in the incidence of adverse events were not significant. The quality of this evidence on the effectiveness of genital ulcer disease treatment in reducing sexual acquisition of HIV, according to GRADE methodology, is of very low quality. AUTHORS' CONCLUSIONS At present, there is insufficient evidence to determine whether curative treatment of genital ulcer disease would reduce the risk of HIV acquisition. The very low quality of the evidence implies that the true effect of genital ulcer disease treatment on sexual acquisition of HIV may be substantially different from the effect estimated from currently available data. However, genital ulcer diseases are public health problems in their own right and patients with these conditions should be treated appropriately; whether the treatment reduces the risk of HIV infection or not.
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Affiliation(s)
- Florence M Mutua
- Department of Medical Microbiology, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
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National estimates of seroincidence and seroprevalence for herpes simplex virus type 1 and type 2 among US military adults aged 18 to 29 years. Sex Transm Dis 2012; 39:241-50. [PMID: 22421688 DOI: 10.1097/olq.0b013e3182401a17] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While population-based seroprevalence studies of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) are widespread, seroincidence studies are largely limited to select or high-risk populations. The US military offers a potential population to derive national seroincidence rate estimates for young adults (ages 18-29). METHODS We used banked, longitudinal serum specimens collected in a cohort of 1094 military personnel aged 18 to 30 years who served between 1989 and 2005 to estimate national HSV-1 and HSV-2 seroincidence and seroprevalence for the young, adult military population, weighted according to the US Census. Serum was tested with indirect ELISA (enzyme-linked immunosorbent assay). RESULTS Estimated national seroincidence rates for the US young, adult military population were 9.1 per 100 person-years (95% confidence interval: 4.6-13.5) for HSV-1 and 6.2 (95% confidence interval: 3.1-9.3) for HSV-2. Female sex and black race were associated with significantly higher HSV-2 seroconversion rates. Our estimated HSV1/2 seroprevalences were comparable to US national data provided by National Health and Nutrition Examination Surveys' serosurveys except for non-Hispanic blacks and Hispanics. CONCLUSION Although these US 2000 Census-weighted estimates of HSV-1 and HSV-2 seroincidence apply only to young, military adults, they nonetheless supply, to our knowledge, the only national figures that might be used to predict US national HSV1/2 seroincidence in young adults. Thus, we believe that our findings in this military population can be used to inform the planning of HSV-1 and 2 prevention measures in the general, young-adult US population.
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Abstract
Nearly all human beings, by the time they reach adolescence, are infected with multiple herpesviruses. At any given time, this family of viruses accounts for 35-40 billion human infections worldwide, making herpesviruses among the most prevalent pathogens known to exist. Compared to most other viruses, herpesviruses are also unique in that infection lasts the life of the host. Remarkably, despite their prevalence and persistence, little is known about how these viruses interact with their hosts, especially during the clinically asymptomatic phase of infection referred to as latency. This review explores data in human and animal systems that reveal the ability of latent herpesviruses to modulate the immune response to self and environmental antigens. From the perspective of the host, there are both potentially detrimental and surprisingly beneficial effects of this lifelong interaction. The realization that latent herpesvirus infection modulates immune responses in asymptomatic hosts forces us to reconsider what constitutes a 'normal' immune system in a healthy individual.
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Affiliation(s)
- Douglas W. White
- Division of Rheumatology, Gundersen Lutheran Medical Center, La Crosse, WI, USA
| | - R. Suzanne Beard
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
- Department of Microbiology & Immunology, Wake Forest University School of Medicine, Winston-Salem NC, USA
| | - Erik S. Barton
- Department of Microbiology & Immunology, Wake Forest University School of Medicine, Winston-Salem NC, USA
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Osinde MO, Kaye DK, Kakaire O. Sexual behaviour and HIV sero-discordance among HIV patients receiving HAART in rural Uganda. J OBSTET GYNAECOL 2011; 31:436-40. [PMID: 21627430 DOI: 10.3109/01443615.2011.578228] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Globally, HIV sero-discordance is a major public health problem, due to increased risk of HIV transmission to HIV-negative partners. From January to August 2009, we assessed the sexual behaviour of HIV-infected patients attending an HIV treatment centre in Uganda and analysed characteristics associated with HIV sero-discordance. Of the 278 respondents, 256 (92.1%) were female, 218 (78.1%) were on antiretroviral drugs and 107 (38.7%) belonged to a sero-discordant couple. In the prior 3 months, 238 (88.5%) had more than one sexual partner and 98 (35.8%) had acquired new sexual partners. Only 171 (61.5%) had ever disclosed sero-status to main sexual partners. Participants who had changed sexual partners in the previous 3 months were more likely to be sero-discordant (OR 1.87, 95% CI 1.13, 3.11). Respondents who used condoms during their last sexual intercourse and those currently on ARVs were significantly less likely to be sero-discordant (OR 0.52 95% CI 0.28, 0.96 and OR 0.52 95% CI 0.30, 0.94, respectively). Only disclosure of sero-status was independently though inversely associated with discordance (adjusted OR 0.41, 95% CI 0.20, 0.64). Our findings indicate that HIV patients continue exhibiting high risk behaviour characterised by changing sexual partners, having multiple sexual partners and non-use of condoms.
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Affiliation(s)
- M O Osinde
- Department of Obstetrics and Gynecology, Kabale Regional Hospital, Kabale, Uganda
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Nowak RG, Gravitt PE, Morrison CS, Gange SJ, Kwok C, Oliver AE, Howard R, Van der Pol B, Salata RA, Padian NS, Chipato T, Munjoma M, Celentano DD. Increases in human papillomavirus detection during early HIV infection among women in Zimbabwe. J Infect Dis 2011; 203:1182-91. [PMID: 21451006 DOI: 10.1093/infdis/jiq172] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Individuals who acquire human immunodeficiency virus (HIV) may experience an immediate disruption of genital tract immunity, altering the ability to mount a local and effective immune response. This study examined the impact of early HIV infection on new detection of human papillomavirus (HPV). METHODS One hundred fifty-five Zimbabwean women with observation periods before and after HIV acquisition and 486 HIV-uninfected women were selected from a cohort study evaluating hormonal contraceptive use and risk of HIV acquisition. Study visits occurred at 3-month intervals. Cervical swab samples available from up to 6 months before, at, and up to 6 months after the visit when HIV was first detected were typed for 37 HPV genotypes or subtypes. RESULTS We observed ∼5-fold higher odds of multiple (≥2) new HPV detections only after HIV acquisition, relative to HIV-negative women after adjusting for sexual behavior and concurrent genital tract infections. We also observed ∼2.5-fold higher odds of single new HPV detections at visits before and after HIV acquisition, relative to HIV-uninfected women in multivariable models. CONCLUSIONS These findings suggest that HIV infection has an immediate impact on genital tract immunity, as evidenced by the high risk of multiple new HPV detections immediately after HIV acquisition.
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Affiliation(s)
- Rebecca G Nowak
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA
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High Human Immunodeficiency Virus Incidence in a Cohort of Rwandan Female Sex Workers. Sex Transm Dis 2011; 38:385-94. [DOI: 10.1097/olq.0b013e31820b8eba] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Virucidal activity of the dendrimer microbicide SPL7013 against HIV-1. Antiviral Res 2011; 90:195-9. [PMID: 21459115 DOI: 10.1016/j.antiviral.2011.03.186] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 03/27/2011] [Accepted: 03/28/2011] [Indexed: 11/24/2022]
Abstract
Topical microbicides for use by women to prevent the transmission of human immunodeficiency virus (HIV) and other sexually transmitted infections are urgently required. Dendrimers are highly branched nanoparticles being developed as microbicides. SPL7013 is a dendrimer with broad-spectrum activity against HIV type I (HIV-1) and -2 (HIV-2), herpes simplex viruses type-1 (HSV-1) and -2 (HSV-2) and human papillomavirus. SPL7013 [3% (w/w)] has been formulated in a mucoadhesive carbopol gel (VivaGel®) for use as a topical microbicide. Previous studies showed that SPL7013 has similar potency against CXCR4-(X4) and CCR5-using (R5) strains of HIV-1 and that it blocks viral entry. However, the ability of SPL7013 to directly inactivate HIV-1 is unknown. We examined whether SPL7013 demonstrates virucidal activity against X4 (NL4.3, MBC200, CMU02 clade EA and 92UG046 clade D), R5 (Ba-L, NB25 and 92RW016 clade A) and dual-tropic (R5X4; MACS1-spln) HIV-1 using a modified HLA-DR viral capture method and by polyethylene glycol precipitation. Evaluation of virion integrity was determined by ultracentrifugation through a sucrose cushion and detection of viral proteins by Western blot analysis. SPL7013 demonstrated potent virucidal activity against X4 and R5X4 strains, although virucidal activity was less potent for the 92UG046 X4 clade D isolate. Where potent virucidal activity was observed, the 50% virucidal concentrations were similar to the 50% effective concentrations previously reported in drug susceptibility assays, indicating that the main mode of action of SPL7013 is by direct viral inactivation for these strains. In contrast, SPL7013 lacked potent virucidal activity against R5 HIV-1 strains. Evaluation of the virucidal mechanism showed that SPL7013-treated NL4.3, 92UG046 and MACS1-spln virions were intact with no significant decrease in gp120 surface protein with respect to p24 capsid content compared to the corresponding untreated virus. These studies demonstrate that SPL7013 is virucidal against HIV-1 strains that utilize the CXCR4 coreceptor but not viruses tested in this study that solely use CCR5 by a mechanism that is distinct from virion disruption or loss of gp120. In addition, the mode of action by which SPL7013 prevents infection of cells with X4 and R5X4 strains is likely to differ from R5 strains of HIV-1.
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Venkatesh KK, van der Straten A, Cheng H, Montgomery ET, Lurie MN, Chipato T, Ramjee G, Blanchard K, Padian NS, Mayer KH, de Bruyn G. The relative contribution of viral and bacterial sexually transmitted infections on HIV acquisition in southern African women in the Methods for Improving Reproductive Health in Africa study. Int J STD AIDS 2011; 22:218-24. [DOI: 10.1258/ijsa.2010.010385] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We assess the relative contribution of viral and bacterial sexually transmitted infections (STIs) on HIV acquisition among southern African women in a nested case-control study within the Methods for Improving Reproductive Health in Africa (MIRA) trial. Cases were women with incident HIV infection; controls were HIV-uninfected at the time of case seroconversion selected in a 1 to 3 case to control ratio (risk-set sampling), matched on study site and time of follow-up. Conditional logistic regression models were used to calculate adjusted odds ratios (AORs) and population-attributable fractions (PAF). Among 4948 enrolled women, we analysed 309 cases and 927 controls. The overall HIV incidence rate was 4.0 per 100 women-years. The incidence of HIV infection was markedly higher in women who had prevalent Herpes simplex virus type 2 (HSV-2) (AOR: 2.14; 95% confidence interval [CI]: 1.55–2.96), incident HSV-2 (AOR: 4.43; 95% CI: 1.77–11.05) and incident Neisseria gonorrhoeae (AOR: 6.92; 95% CI: 3.01–15.90). The adjusted PAF of HIV incidence for prevalent HSV-2 was 29.0% (95% CI: 16.8–39.3), for incident HSV-2 2.1% (95% CI: 0.6–3.6) and for incident N. gonorrhoeae 4.1% (95% CI: 2.5–5.8). Women's greatest risk factors for HIV acquisition were incident bacterial and viral STIs. Women-centred interventions aimed at decreasing HIV incidence in young African women need to address these common co-morbid conditions.
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Affiliation(s)
- K K Venkatesh
- Department of Community Health, Division of Infectious Diseases
- Department of Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - A van der Straten
- Women's Global Health Imperative, RTI International
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - H Cheng
- Women's Global Health Imperative, RTI International
| | | | - M N Lurie
- Department of Community Health, Division of Infectious Diseases
- Department of Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - T Chipato
- University of Zimbabwe, Harare, Zimbabwe
| | - G Ramjee
- HIV Prevention Research Unit, Medical Research Council, Durban, South Africa
| | | | - N S Padian
- Department of Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - K H Mayer
- Department of Community Health, Division of Infectious Diseases
- Department of Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - G de Bruyn
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
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Jin X, Chan S, Ding G, Wang H, Xu J, Wang G, Chang D, Reilly KH, Wang N. Prevalence and risk behaviours for Chlamydia trachomatis and Neisseria gonorrhoeae infection among female sex workers in an HIV/AIDS high-risk area. Int J STD AIDS 2011; 22:80-4. [DOI: 10.1258/ijsa.2010.010289] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- X Jin
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control & Prevention, Beijing
| | - S Chan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control & Prevention, Beijing
| | - G Ding
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control & Prevention, Beijing
| | - H Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control & Prevention, Beijing
| | - J Xu
- Key Laboratory of Immunology of AIDS, Ministry of Health, First Hospital of China Medical University
| | - G Wang
- Kaiyuan City Center for Disease Control & Prevention, Yunnan Province, PRChina
| | - D Chang
- Kaiyuan City Center for Disease Control & Prevention, Yunnan Province, PRChina
| | - K H Reilly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
- Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - N Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control & Prevention, Beijing
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46
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Hagan H, Jenness SM, Wendel T, Murrill CR, Neaigus A, Gelpi-Acosta C. Herpes simplex virus type 2 associated with HIV infection among New York heterosexuals living in high-risk areas. Int J STD AIDS 2011; 21:580-3. [PMID: 20975092 DOI: 10.1258/ijsa.2010.010137] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Herpes simplex virus type 2 (HSV-2) has been shown to increase the risk of sexual human immunodeficiency virus (HIV) transmission. A matched case-control design was used to examine the association between HSV-2 and HIV infection among heterosexuals in 'high-risk areas' (HRAs) in New York City (NYC). We identified NYC HRAs using HIV surveillance data on heterosexual-related adult HIV diagnoses and USA census data on household poverty. Heterosexuals who were socially or geographically linked to an HRA were recruited using respondent-driven sampling. HIV prevalence was 8.6% and HSV-2 prevalence was 80.1%. Only 6% of HIV-positives knew they were infected. HIV-positive cases were matched to HIV-negative controls on gender, race/ethnicity and age, and tested for antibody to HSV-2. In a multivariate model, HIV infection was associated with HSV-2 infection (adjusted odds ratio [AOR] = 3.5, 95% confidence interval 1.1-11.7) and non-HSV-related sexually transmitted infection diagnosis in the previous year (AOR = 2.6, 1.1-6.2). Effective approaches to HIV risk reduction for individuals with HSV-2 remain uncertain, and these are urgently needed in high-risk communities where multiple social, behavioural and biological factors that facilitate HIV infection coexist.
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Affiliation(s)
- H Hagan
- New York University College of Nursing, New York, NY 10003, USA.
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Mayer KH, Venkatesh KK. Interactions of HIV, other sexually transmitted diseases, and genital tract inflammation facilitating local pathogen transmission and acquisition. Am J Reprod Immunol 2011; 65:308-16. [PMID: 21214660 DOI: 10.1111/j.1600-0897.2010.00942.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Despite several decades of clinical trials assessing the impact of etiological treatment of sexually transmitted diseases (STDs) to decrease HIV acquisition and transmission, almost all of these trials have not proven to be efficacious. Increasing evidence suggests that specific STD treatment alone may not be sufficient to alter the genital tract inflammatory milieu that is created by STDs. This paper examines the associations between STDs and HIV susceptibility and infectiousness, and considers the role of chronic and refractory inflammation to create an environment that potentiates HIV and STD transmission and acquisition by reviewing biological, observational, and clinical trial data.
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Affiliation(s)
- Kenneth H Mayer
- Division of Infectious Diseases, Department of Medicine, Alpert Medical School, Brown University, Providence, RI 02906, USA.
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48
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Prevalence- and gender-specific immune response to opportunistic infections in HIV-infected patients in Lesotho. Sex Transm Dis 2010; 37:454-9. [PMID: 20531031 DOI: 10.1097/olq.0b013e3181cfcc2b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of this study was to assess the seroprevalence of coinfecting viruses and Treponema pallidum (T. pallidum) in a cohort of 205 antiretrovirally treated HIV-infected individuals (152 females and 53 males, aged: 19-71 years) in rural Lesotho. Furthermore agent-specific immune responses were investigated by analyzing antibody titers against herpes simplex virus type 2 (HSV-2) and against T. pallidum. METHODS Serum samples were tested by enzyme-linked immunosorbent assay for antibodies against HSV-2, cytomegalovirus, hepatitis A, B, and C viruses, and T. pallidum. RESULTS Seroprevalences (95% confidence intervals) were found to be 100% (98.5%-100%) for anti-cytomegalovirus, 98.5% (95.7%-99.7%) for anti-hepatitis A virus, 35.5% (28.9%-42.6%) for anti-HBc, 5.5% (2.8%-9.6%) for hepatitis B surface antigen, and 0.5% (0.0%-2.8%) for anti-hepatitis C virus. Only 78.5% (72.2%-84.0%) were anti-HSV-2 positive and 29.0% (22.8%-35.8%) had antibodies against T. pallidum. Only anti-HSV-2 titers showed gender- and CD4 cell-count dependent differences: females with >500 CD4 cells/microL had an average anti-HSV-2 titer of 446 compared with males of 398 AU/mL (not significant), but in those with 250 to 500 CD4 cells/microL, there was a significant difference with a mean titer of 467 compared to 302 AU/mL in males (P = 0.001). CONCLUSIONS A high seroprevalence of CMV, HAV, and HBV was found in both genders. One-third of the patients had been exposed to HBV and T. pallidum. The generally high HSV-2 prevalence showed gender- and CD4 cell count-dependent differences in HSV-2 antibody titer.
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Tyssen D, Henderson SA, Johnson A, Sterjovski J, Moore K, La J, Zanin M, Sonza S, Karellas P, Giannis MP, Krippner G, Wesselingh S, McCarthy T, Gorry PR, Ramsland PA, Cone R, Paull JRA, Lewis GR, Tachedjian G. Structure activity relationship of dendrimer microbicides with dual action antiviral activity. PLoS One 2010; 5:e12309. [PMID: 20808791 PMCID: PMC2925893 DOI: 10.1371/journal.pone.0012309] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Accepted: 07/25/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Topical microbicides, used by women to prevent the transmission of HIV and other sexually transmitted infections are urgently required. Dendrimers are highly branched nanoparticles being developed as microbicides. However, the anti-HIV and HSV structure-activity relationship of dendrimers comprising benzyhydryl amide cores and lysine branches, and a comprehensive analysis of their broad-spectrum anti-HIV activity and mechanism of action have not been published. METHODS AND FINDINGS Dendrimers with optimized activity against HIV-1 and HSV-2 were identified with respect to the number of lysine branches (generations) and surface groups. Antiviral activity was determined in cell culture assays. Time-of-addition assays were performed to determine dendrimer mechanism of action. In vivo toxicity and HSV-2 inhibitory activity were evaluated in the mouse HSV-2 susceptibility model. Surface groups imparting the most potent inhibitory activity against HIV-1 and HSV-2 were naphthalene disulfonic acid (DNAA) and 3,5-disulfobenzoic acid exhibiting the greatest anionic charge and hydrophobicity of the seven surface groups tested. Their anti-HIV-1 activity did not appreciably increase beyond a second-generation dendrimer while dendrimers larger than two generations were required for potent anti-HSV-2 activity. Second (SPL7115) and fourth generation (SPL7013) DNAA dendrimers demonstrated broad-spectrum anti-HIV activity. However, SPL7013 was more active against HSV and blocking HIV-1 envelope mediated cell-to-cell fusion. SPL7013 and SPL7115 inhibited viral entry with similar potency against CXCR4-(X4) and CCR5-using (R5) HIV-1 strains. SPL7013 was not toxic and provided at least 12 h protection against HSV-2 in the mouse vagina. CONCLUSIONS Dendrimers can be engineered with optimized potency against HIV and HSV representing a unique platform for the controlled synthesis of chemically defined multivalent agents as viral entry inhibitors. SPL7013 is formulated as VivaGel(R) and is currently in clinical development to provide protection against HIV and HSV. SPL7013 could also be combined with other microbicides.
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Affiliation(s)
- David Tyssen
- Centres for Virology and Immunology, Burnet Institute, Melbourne, Victoria, Australia
| | | | - Adam Johnson
- Centres for Virology and Immunology, Burnet Institute, Melbourne, Victoria, Australia
| | - Jasminka Sterjovski
- Centres for Virology and Immunology, Burnet Institute, Melbourne, Victoria, Australia
| | - Katie Moore
- Centres for Virology and Immunology, Burnet Institute, Melbourne, Victoria, Australia
| | - Jennifer La
- Centres for Virology and Immunology, Burnet Institute, Melbourne, Victoria, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Mark Zanin
- Centres for Virology and Immunology, Burnet Institute, Melbourne, Victoria, Australia
| | - Secondo Sonza
- Centres for Virology and Immunology, Burnet Institute, Melbourne, Victoria, Australia
- Department of Microbiology, Monash University, Clayton, Victoria, Australia
| | | | | | - Guy Krippner
- Starpharma Pty Ltd, Melbourne, Victoria, Australia
| | - Steve Wesselingh
- Centres for Virology and Immunology, Burnet Institute, Melbourne, Victoria, Australia
- Faculty of Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Tom McCarthy
- Starpharma Pty Ltd, Melbourne, Victoria, Australia
| | - Paul R. Gorry
- Centres for Virology and Immunology, Burnet Institute, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, University of Melbourne, Parkville, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paul A. Ramsland
- Centres for Virology and Immunology, Burnet Institute, Melbourne, Victoria, Australia
- Department of Surgery (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia
- Department of Immunology, Monash University, Melbourne, Victoria, Australia
| | - Richard Cone
- Department of Biophysics, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | | | - Gilda Tachedjian
- Centres for Virology and Immunology, Burnet Institute, Melbourne, Victoria, Australia
- Department of Microbiology, Monash University, Clayton, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
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50
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Mahiane SG, Nguéma EPN, Pretorius C, Auvert B. Mathematical models for coinfection by two sexually transmitted agents: the human immunodeficiency virus and herpes simplex virus type 2 case. J R Stat Soc Ser C Appl Stat 2010. [DOI: 10.1111/j.1467-9876.2010.00719.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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