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HSV-2 underrecognized in HIV-positive patients: subclinical infection.

OTTAWA--Herpes simplex virus type 2 infection is prevalent--and largely unrecognized--among HIV-positive patients.

Epidemiologists have recognized for two decades that the presence of genital ulcers heightens the risk for transmission of HIV. But it is now known that even asymptomatic HSV-2 infection can increase HIV transmissibility.

"Both subclinical and clinical HSV-2 reactivation increase the frequency and amount of mucosal HIV-1 shedding," Dr. Jennifer L. Meyer said at a congress of the International Society for Sexually Transmitted Diseases Research.

In a survey of 246 patients at a Seattle HIV clinic, 172 (70%) were HSV-2 seropositive; 42 had a history of symptomatic genital herpes but only 20 had received suppressive therapy, Dr. Meyer said. A total of 130 (76%) of those who were seropositive for HSV-2 were not aware that they had the infection. Most HSV-2 infections are subclinical, and current guidelines do not advocate routine serologic testing for HSV-2. But with more than 60% of the patients in the survey reporting sexual activity, often with multiple partners, this lack of recognition and treatment may lead to higher transmission rates for both HSV-2 and HIV, she said.

In the survey, which was presented in a poster session, 122 of the 140 men who were HSV-2 seropositive (87%) reported having sex with other men. Of the 38 women tested, 32 (84%) were seropositive for HSV-2.

During the previous 2 months, 42 (24%) of the 172 HSV-2 positive patients had more than two sex partners, she said.

The median CD4 count among the HSV-2 positive patients was 341 cells/[micro]L, compared to 372 cells/[micro]L among those not infected with HSV-2.

Prior antiretroviral therapy was reported by 27 patients, and current therapy by 112. These patients were receiving regular HIV care, and had ready access to HSV-2 serologic testing, said Dr. Meyer of the Virology Research Clinic, University of Washington, Seattle.

"The high frequency of unrecognized infection suggests a need for routine HSV-2 serologic testing among HIV-seropositive persons," she said. "Management of HSV-2 infection with suppressive therapy may be a good public health intervention in helping to prevent HIV transmission and acquisition. Generic acyclovir is inexpensive and safe, even for long-term use." (J. Infect. Dis. 187[10]: 1509-12, 2003).
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Title Annotation:Gynecology
Publication:OB GYN News
Date:Sep 15, 2003
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