HSV-2 co-infection as a driver of HIV transmission among heterosexual non-injecting drug users in New York City

• Published in: PloS one 2014-01, Vol.9 (1), p.e87993
• Main Authors: Des Jarlais, Don C, Arasteh, Kamyar, McKnight, Courtney, Perlman, David C, Feelemyer, Jonathan, Hagan, Holly, Cooper, Hannah L F
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Cocaine; Cocaine-Related Disorders - complications; Cocaine-Related Disorders - epidemiology; Demographics; Detoxification; Detoxification (Substance abuse treatment); Disease transmission; Drug abuse; Drug use; Drug Users; Female; Females; Health aspects; Health care facilities; Health risk assessment; Health risks; Heroin; Heroin Dependence - complications; Heroin Dependence - epidemiology; Herpes Genitalis - epidemiology; Herpes Genitalis - transmission; Herpes simplex; Herpesvirus 2, Human; Heterosexuality; HIV; HIV infections; HIV Infections - epidemiology; HIV Infections - transmission; Human immunodeficiency virus; Humans; Infection; Infections; Male; Males; Medical centers; Medicine; Methadone; Middle Aged; New York City - epidemiology; Prevalence; Retrospective Studies; Risk factors; Sex Factors; Social and Behavioral Sciences; Subgroups; Surveys; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0087993

To examine herpes simplex virus 2 (HSV-2)/HIV co-infection as a contributing factor in the increase in HIV infection among non-injecting heroin and cocaine users in New York City. Subjects were recruited from the Beth Israel Medical Center drug detoxification and methadone maintenance programs in New York City in 1995-1999 and 2005-2011. All reported current heroin and/or cocaine use and no injection drug use. A structured questionnaire was administered and serum samples collected for HIV and HSV-2 testing. Population-attributable risk percentages (PAR%s) were estimated for associations between HSV-2 and increased susceptibility to and increased transmissibility of HIV among female NIDUs. 785 subjects were recruited from 1995-1999, and 1764 subjects from 2005-2011. HIV prevalence increased from 7% to 13%, with nearly uniform increases among all demographic subgroups. HSV-2/HIV co-infection was common in both time periods, with an average (over the two time periods) of 80% of HIV negative females infected with HSV-2, an average of 43% of HIV negative males infected with HSV-2; an average of 97% of HIV positive females also infected with HSV-2 and an average of 67% of HIV positive males also infected with HSV-2. The increase in HIV prevalence was predominantly an increase in HSV-2/HIV co-infection, with relatively little HIV mono-infection in either time period. The estimated PAR%s indicate that approximately half of HIV acquisition among females was caused by HSV-2 infection and approximately 60% of HIV transmission from females was due to HSV-2 co-infection. The increase in HIV infection among these non-injecting drug users is better considered as an increase in HSV-2/HIV co-infection rather than simply an increase in HIV prevalence. Additional interventions (such as treatment as prevention and suppressing the effects of HSV-2 on HIV transmission) are needed to reduce further HIV transmission from HSV-2/HIV co-infected non-injecting drug users.