HIV-positive women who are pregnant are more likely to have antibodies to herpes simplex virus-2 (HSV-2) detected and to shed the virus at delivery, according to a study recently published in Infectious Diseases in Obstetrics and Gynecology.
HIV and HSV “co-infections” are increasingly of interest to researchers. Genital HSV (usually HSV-2) increases the risk for HIV acquisition, and both viral shedding and outbreaks of genital herpes tend to be more active among those who also have HIV. This relationship between the two has led to numerous studies on the interaction between HSV-2 and HIV, and investigators are also turning their eyes toward the HIV/HSV-2 dynamic and pregnant women.
To assess the impact of HIV on both HSV-2 prevalence and viral shedding at delivery, women who delivered at the University of Washington Medical Center between 1989 and 1996 were given type-specific HSV-2 blood tests as part of their routine prenatal care (both HIV-positive and HIV-negative women were included).
Among 75 HIV-positive women in the study, HSV-2 antibodies were detected in an astonishing 71%, compared to only 30% of 622 HIV-negative subjects. Genital swabs taken from HSV-2 seropositive women indicated viral shedding at delivery was more than three times higher among those with HIV: among 26 HIV/HSV-2 co-infected women, genital HSV-2 was detected at delivery in 31%. This compares to HSV-2 shedding detected in only 9.5% of HIV-negative women.
Neonatal HSV transmission is actually an uncommon occurrence that most often happens when the virus is being shed at delivery, which makes the higher shedding rates among HIV-positive women in this study especially troubling. Infants at greatest risk are those born to mothers who contract genital herpes late in pregnancy, when the maternal antibody response (which is shared with and protects the baby) isn’t able to fully develop prior to delivery.
A regimen of daily therapy in pregnant women to suppress genital HSV-2 lesions at delivery is sometimes utilized, but the authors point out the need for more studies evaluate if this actually reduces neonatal transmission.
Patterson J, Hitti J, Selke S, Huang ML, Watts H, Brown Z, Corey L, and Wald A. Genital HSV detection among HIV-1 infected pregnant women in labor. Infect Dis in Obstet Gynecol 2011. 2011: 157680. Abstract available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068304/