Schacker T, Ryncarz A, Goddard J, Diem K, Shaughnessy M, Corey L; University of Washington, Seattle, WA.
HSV-2 is the most common cause of genital ulceration in North America and is found in 60-80% of HIV-infected persons. To determine if genital herpes lesions might be a cofactor in HIV transmission, we initiated a prospective study of HIV shedding from genital herpetic lesions. 12 HIV infected men with HSV2 infection who received no anti-HSV therapy were followed at every other day intervals through 24 episodes of HSV-2 reactivation. At each visit genital lesions were swabbed for HSV culture and HIV RNA PCR; similar swabs were taken from intact genital skin when lesions were healed. Overall, we detected HIV RNA in genital lesion swabs in 23 (96%) of the 24 genital herpes epidoes. HIV RNA was detected in genital lesion swabs on 112 (60%) of the 170 days sampled. HIV RNA was detected in genital lesions from persons with both low and high plasma HIV RNA (10,000 to 100,000 copies/ml) and at all anatomic sites sampled; 50% of lesional swabs had at least 1 sample with greater than 5,000 copies HIV RNA per 200 µLs swab sample. Exclusion of the RT step in the PCR assay indicated all of the HIV nucleic acid detected was virion RNA and not proviral DNA. Heteroduplex analyses showed that viral quasispecies found in genital lesions subsequently appeared in serum, indicating the replication competence of the HIV quasispecies found in the genital sample. The presence of HSV by culture was correlated with detection of HIV RNA by PCR (O.R. 3.97, 95% C.I. 1.84-8.64, Chi Square). HIV RNA is frequently detected in lesions caused by HSV-2. Herpetic ulcers are likely to be a major cofactor in transmission of HIV during sexual contact. Studies to examine the effect of anti-HSV therapy on HIV detection in genital lesions are warranted to determine if HIV transmission rate could be reduced by HSV-2 suppression.
Keywords: AEGIS, Simplexvirus, HIV, Herpesvirus 2, Human, Herpes Genitalis, HIV Infections, Polymerase Chain Reaction, Sexually Transmitted Diseases, Infection, Viremia, Prospective Studies, North America, Human, Male, pathogenicity, AIDS
