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Title: Prevalence, Incidence and Risk Factors of Herpes Simplex Virus Type 2 Infection (Hsv-2) Among Hiv-Seronegative Women at High-Risk Of Hiv Infection: A Prospective Study in Beira, Mozambique
Authors: Meque, Ivete da Conceição Pedro
Keywords: Herpes simplex virus type-2
HIV acquisition
risk factors
Issue Date: 29-May-2013
Abstract: OBJECTIVES: To estimate the prevalence, incidence and risk factors of HSV-2 infection and associations between HSV-2 and incident HIV infections, among initially HIV-seronegative women in Beira, Mozambique. METHODS: A longitudinal study was conducted among 411 women aged 18 – 35 years at high risk of HIV acquisition (defined as having had two or more sexual partners in the month prior to study enrolment). Questionnaires were completed to establish demographic, socioeconomic and sexual behavioural characteristics at baseline. Women were followed up monthly and blood was drawn to detect HSV-2 and HIV antibodies. HSV-2 testing was requested at the enrolment visit and at exit from the study (either on the final visit or upon HIV seroconversion, if negative at enrolment). HIV testing was performed at every monthly visits. Factors associated with prevalent and incident HSV-2 infection were analysed using logistic regression models, with associations represented as odds ratios (OR) with 95% confidence intervals (CI). A subsequent analysis assessed HSV-2 status as an explanatory variable and HIV seroconversion as the outcome variable, with the aim to evaluate the associations between both infections. Univariable analysis with a Cox proportional hazard model was used to calculate hazard ratios (HR) and 95% CI. RESULTS: The overall HSV-2 prevalence at baseline was 60.6% (95 % CI: 55.7%–65.4%) and increased with age from 43.6 % in women aged 18-20 years to 80% in women aged 25-35 years. Multivariable analysis found that increasing age, having had less than high school education (secondary school [grade 6-9] only), having worked full time and having practiced oral sex were strongly associated with prevalent HSV-2 infection at baseline. Having a primary partner (PP) who had sex with others in the last 6 months was borderline significant with an adjusted OR (aOR) = 1.67 (95% CI: 0.99–2.80, P=0.053). Conversely, having been forced to have sex in the last month (aOR=0.31, 95% CI: 0.15–0.66, P=0.003) was associated with reduced risk of prevalent HSV-2 infection. There were 31 participants who seroconverted to HSV-2 and 22 who seroconverted to HIV during the study period. Median follow-up time was 6 months (Inter-quartile range 3–9 months). The HSV-2 cumulative incidence was 20.5% among the study population during the follow-up period. Factors independently associated with incident HSV-2 infections were frequency of vaginal sex with a casual partner (CP) using a condom in the last 7 days (aOR=1.91, 95% CI: 1.05–3.47, P=0.034) and age between 21–24 years (aOR=2.36, 95% CI: 0.98–5.71, P=0.057), although the latter had borderline significance. The HR for HIV acquisition among women who were HSV-2 positive at baseline and those who seroconverted to HSV-2 during follow up were not significantly different from HSV-2 negative women, although the findings suggest positive associations between prevalent and incident HSV-2 infections and HIV acquisition. CONCLUSIONS: This study confirmed that vulnerable women engaged in risky sexual behaviours had a high risk of HSV-2 infection in Beira, Mozambique. Strategies aimed at discouraging having multiple sexual partners and unprotected sex among young women in Mozambique, particularly in those at higher risk, are urgently needed and may contribute to a reduction in new HIV and HSV-2 infections.
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