Decline in Herpes Simplex Virus Type 2 Among Non-Injecting Heroin and Cocaine Users in New York City, 2005 to 2014: Prospects for Avoiding a Resurgence of Human Immunodeficiency Virus

• Published in: Sexually transmitted diseases 2017-02, Vol.44 (2), p.85-90
• Main Authors: Des Jarlais, Don C., Arasteh, Kamyar, Feelemyer, Jonathan, McKnight, Courtney, Tross, Susan, Perlman, David C., Campbell, Aimee N.C., Hagan, Holly, Cooper, Hannah L.F.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; At risk; Cities; Cocaine; Cocaine-Related Disorders - complications; Cocaine-Related Disorders - epidemiology; Coinfection; Comparative analysis; Confidence intervals; Disease prevention; Drug abuse; Drug addiction; Drug use; Drug Users; Epidemics; Female; Heroin; Heroin Dependence - complications; Heroin Dependence - epidemiology; Herpes simplex; Herpes Simplex - epidemiology; Herpes Simplex - transmission; Herpes viruses; Herpesviridae; Herpesvirus 2, Human - isolation & purification; Heterosexuality; HIV; HIV Infections - epidemiology; HIV Infections - transmission; Human immunodeficiency virus; Human immunodeficiency virus 2; Humans; Immune disorders; Incidence; Infections; Intravenous drug addicts; Lentivirus; Male; Medical treatment; Middle Aged; Narcotics; New York City - epidemiology; Original Study; Prevalence; Prevention programs; Preventive medicine; Prospects; Retroviridae; Sex education; Structured interviews; Substance abuse; Substance abuse treatment; Substance Abuse, Intravenous - complications; Substance Abuse, Intravenous - epidemiology; Substance use; Susceptibility; Treatment methods; Viruses; Young Adult
• ISSN: 0148-5717; 1537-4521
• DOI: 10.1097/OLQ.0000000000000549

BACKGROUNDHerpes simplex virus type 2 (HSV-2) infection increases both susceptibility to and transmissibility of human immunodeficiency virus (HIV), and HSV-2 and HIV are often strongly associated in HIV epidemics. We assessed trends in HSV-2 prevalence among non-injecting drug users (NIDUs) when HIV prevalence declined from 16% to 8% among NIDUs in New York City. METHODSSubjects were current non-injecting users of heroin and/or cocaine and who had never injected illicit drugs. Three thousand one hundred fifty-seven NIDU subjects were recruited between 2005 and 2014 among persons entering Mount Sinai Beth Israel substance use treatment programs. Structured interviews, HIV, and HSV-2 testing were administered. Change over time was assessed by comparing 2005 to 2010 with 2011 to 2014 periods. Herpes simplex virus type 2 incidence was estimated among persons who participated in multiple years. RESULTSHerpes simplex virus type 2 prevalence was strongly associated with HIV prevalence (odds ratio, 3.9; 95% confidence interval, 2.9–5.1) from 2005 to 2014. Herpes simplex virus type 2 prevalence declined from 60% to 56% (P = 0.01). The percentage of NIDUs with neither HSV-2 nor HIV infection increased from 37% to 43%, (P < 0.001); the percentage with HSV-2/HIV coinfection declined from 13% to 6% (P < 0.001). Estimated HSV-2 incidence was 1 to 2/100 person-years at risk. CONCLUSIONSThere were parallel declines in HIV and HSV-2 among NIDUs in New York City from 2005 to 2014. The increase in the percentage of NIDUs with neither HSV-2 nor HIV infection, the decrease in the percentage with HSV-2/HIV coinfection, and the low to moderate HSV-2 incidence suggest some population-level protection against resurgence of HIV. Prevention efforts should be strengthened to end the combined HIV/HSV-2 epidemic among NIDUs in New York City.