Results from a large study spanning 15 years confirm that HSV infections are common among HIV patients.
Researchers from the University of Washington and the King County Health Department in Seattle examined the medical records of 62,299 HIV-infected individuals to determine how many also had a confirmed HSV diagnosis, or received prescription medication for herpes. The subjects were part of the Adult/Adolescent Spectrum of HIV Disease Project (ASD) from 1989-2004.
20% of the subjects had an HSV-1 or HSV-2 diagnosis (the majority of which were anogenital infections) and 32% had been prescribed an HSV medication. That more individuals were treated for herpes than were diagnosed suggests a number of cases were not captured or recorded properly (or diagnosis was made on reported symptoms only), so the actual burden of HSV in these subjects is likely under-represented.
HSV diagnosis decreased by approximately 31% over the life of study, which the authors say could be associated with factors that include more effective HIV treatment regimens gaining a foothold during this time, which subsequently improved immune responses and made herpes outbreaks less frequent, and therefore less likely to be treated. They also mention suppressive therapy for HSV itself as a possible factor in the declining HSV diagnosis.
The authors write “Providers can expect that a significant proportion of their patients with HIV will require therapy for HSV disease,” and suggest more effort be made to educate providers about genital herpes in HIV-positive patients, including the efficacy of suppressive antiviral therapy in managing HSV diseases.
HSV-2 infection is an important dynamic in HIV transmission and progression: according to the Centers for Disease Control and Prevention, genital ulcers from HSV allow easier entry of fluids that carry HIV, and the inflammation caused by outbreaks attracts an abundance of the cells that HIV targets. Also, HIV transmission is more likely to occur from those also infected with HSV-2.
Keating T, Kurth A, Wald A, Kahle E, Barash E, Buskin S. Clinical burden of herpes simplex virus disease in people with human immunodeficiency virus. STD, 2012. 39(5):372-376.