Effect of genital herpes on cervicovaginal HIV shedding in women co-infected with HIV AND HSV-2 in Tanzania.

To compare the presence and quantity of cervicovaginal HIV among
HIV seropositive women with clinical herpes, subclinical HSV-2
infection and without HSV-2 infection respectively; to evaluate the
association between cervicovaginal HIV and HSV shedding; and
identify factors associated with quantity of cervicovaginal HIV.
Four groups of HIV seropositive adult female barworkers were
identified and examined at three-monthly intervals between October
2000 and March 2003 in Mbeya, Tanzania: (1) 57 women at 70 clinic
visits with clinical genital herpes; (2) 39 of the same women at 46
clinic visits when asymptomatic; (3) 55 HSV-2 seropositive women at
60 clinic visits who were never observed with herpetic lesions; (4)
18 HSV-2 seronegative women at 45 clinic visits. Associations of
genital HIV shedding with HIV plasma viral load (PVL), herpetic
lesions, HSV shedding and other factors were examined. Prevalence
of detectable genital HIV RNA varied from 73% in HSV-2 seronegative
women to 94% in women with herpetic lesions (geometric means 1634
vs 3339 copies/ml, p = 0.03). In paired specimens from HSV-2
positive women, genital HIV viral shedding was similar during
symptomatic and asymptomatic visits. On multivariate regression,
genital HIV RNA (log10 copies/mL) was closely associated with HIV
PVL (β = 0.51 per log10 copies/ml increase, 95%CI:0.41-0.60,
p