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1 May 2007

Volume 195, Number 9
The Journal of Infectious Diseases 2007;195:1260–1269
© 2007 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2007/19509-0006$15.00
DOI: 10.1086/513566
MAJOR ARTICLE

The Role of Herpes Simplex Virus Type 2 and Other Genital Infections in the Acquisition of HIV‐1 among High‐Risk Women in Northern Tanzania

Saidi H. Kapiga,1,6

Noel E. Sam,6,7

Heejung Bang,4

Quanhong Ni,4

Trong T. H. Ao,1

Ireen Kiwelu,6,7

Sarah Chiduo,6,7

Uzodinma Ndibe,6

George Seage III,2

Paul Coplan,5

John Shao,6

Zeda F. Rosenberg,5 and

Max Essex3

Departments of 1Population and International Health, 2Epidemiology, and 3Immunology and Infections Diseases, Harvard School of Public Health, Boston, Massachusetts; 4Division of Biostatistics and Epidemiology, Department of Public Health, Weill Medical College of Cornell University, New York, New York; 5International Partnership for Microbicides, Silver Spring, Maryland; 6Kilimanjaro Reproductive Health Program and 7Department of Clinical Laboratories, Kilimanjaro Christian Medical Centre, Moshi, Tanzania

Background.We examined the role of herpes simplex virus type 2 (HSV‐2) and other genital infections on human immunodeficiency virus type 1 (HIV‐1) incidence in a cohort study conducted between 2002 and 2005 among female bar/hotel workers in Moshi, Tanzania.

Methods.At baseline and every 3 months thereafter, participants were interviewed, and blood and genital samples were collected. Predictors of HIV‐1 incidence were evaluated using a Cox proportional hazards regression model.

Results.Of 845 women who were HIV‐1 seronegative at baseline, 689 (81.5%) were monitored in the study for a total of 698.6 person‐years at risk (PYARs). The overall HIV‐1 incidence was 4.6/100 PYARs (95% confidence interval [CI], 3.0–6.2/100 PYARs), and condom use was very low. After adjustment for other risk factors, the risk of HIV‐1 was increased among women with HSV‐2 at baseline (hazard ratio [HR], 4.3 [95% CI, 1.5–12.4]) and in those who acquired HSV‐2 during the study period (HR, 5.5 [95% CI, 1.2–25.4]). Other independent predictors of HIV‐1 were baseline chlamydial infection (HR, 5.2), bacterial vaginosis (HR, 2.1), and the occurrence of genital ulcers (HR, 2.7).

Conclusion.HSV‐2 and other genital infections were the most important risk factors for HIV‐1. Control of these infections could help to reduce HIV‐1 incidence in this population.

Received 5 June 2006; accepted 10 November 2006; electronically published 15 March 2007.

  • (See the editorial commentary by Corey, on pages 1242–4, and the article by Cachay et al., on pages 1270–7.)

Reprints or correspondence: Saidi H. Kapiga, Harvard School of Public Health, Dept. of Population and International Health, 665 Huntington Ave., Bldg. 1‐1105 Boston, MA 02115 ().

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Aaron AR Tobian, Thomas C Quinn. (2009) Herpes simplex virus type 2 and syphilis infections with HIV: an evolving synergy in transmission and prevention. Current Opinion in HIV and AIDS 4:4, 294-299
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Nicoli Nattrass. (2009) Poverty, Sex and HIV. AIDS and Behavior
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Joelle Sobngwi‐Tambekou, Dirk Taljaard, Pascale Lissouba, Kevin Zarca, Adrian Puren, Emmanuel Lagarde, and Bertran Auvert. (2009) Effect of HSV‐2 Serostatus on Acquisition of HIV by Young Men: Results of a Longitudinal Study in Orange Farm, South Africa. The Journal of Infectious Diseases 199:7, 958-964
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Barbara Romanowski, Linda N. Myziuk, Sharon L. Walmsley, Sylvie Trottier, Ameeta E. Singh, Stanley Houston, Mark Joffe, Isabelle Chiu. (2009) Seroprevalence and Risk Factors for Herpes Simplex Virus Infection in a Population of HIV-Infected Patients in Canada. Sexually Transmitted Diseases 36:3, 165-169
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Musie Ghebremichael, Elijah Paintsil, Ulla Larsen. (2009) Alcohol Abuse, Sexual Risk Behaviors, and Sexually Transmitted Infections in Women in Moshi Urban District, Northern Tanzania. Sexually Transmitted Diseases 36:2, 102-107
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PD Griffiths. (2009) Treatment of herpesvirus cofactors?. Reviews in Medical Virology 19:1, 1-6
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Matthew F Chersich, Helen V Rees. (2009) Vulnerability of women in southern Africa to infection with HIV: biological determinants and priority health sector interventions. AIDS 22:Suppl 4, S27-S40
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Joseph C. Fisher, Peter A. Cook, Noel E. Sam, Saidi H. Kapiga. (2008) Patterns of Alcohol Use, Problem Drinking, and HIV Infection Among High-Risk African Women. Sexually Transmitted Diseases 35:6, 537-544
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David M. Koelle, Lawrence Corey. (2008) Herpes Simplex: Insights on Pathogenesis and Possible Vaccines. Annual Review of Medicine 59:1, 381-395
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Deborah Watson-Jones, Helen A Weiss, Mary Rusizoka, Kathy Baisley, Kokugonza Mugeye, John Changalucha, Dean Everett, Rebecca Balira, Louise Knight, David Ross, Richard J Hayes. (2008) Risk Factors for Herpes Simplex Virus Type 2 and HIV Among Women at High Risk in Northwestern Tanzania. JAIDS Journal of Acquired Immune Deficiency Syndromes 46:5, 631-642
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Lawrence Corey. (2007) Herpes Simplex Virus Type 2 and HIV‐1: The Dialogue between the 2 Organisms Continues. The Journal of Infectious Diseases 195:9, 1242-1244
Online publication date: 1-May-2007.
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  • Potential conflicts of interest: none reported.

    Financial support: Rockefeller Foundation (grant 2002 HE 036); International Partnership for Microbicides.

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