Vitamin A supplementation and genital shedding of herpes simplex virus among HIV-1-infected women: a randomized clinical trial.

Department of Epidemiology, University of Washington, Seattle, Washington 98104-2499, USA.
The Journal of Infectious Diseases (Impact Factor: 5.78). 05/2004; 189(8):1466-71. DOI: 10.1086/383049
Source: PubMed

ABSTRACT Cross-sectional analyses have associated vitamin A deficiency with genital shedding of herpes simplex virus (HSV) among human immunodeficiency virus type 1 (HIV-1)-infected women. A randomized clinical trial of vitamin A supplementation given daily for 6 weeks was conducted among 376 women in Mombasa, Kenya, who were coinfected with HSV-2 and HIV-1. At follow-up, there was no significant difference in the detection of genital HSV DNA between women receiving vitamin A supplementation and women receiving placebo (40% vs. 44%, respectively; P = .5) Among women shedding HSV, there was no significant difference in the mean HSV DNA quantity between the group that received vitamin A supplementation and the group that received placebo (4.51 vs. 4.67 log10 copies/swab; P = .6). HSV shedding was associated with significantly higher vaginal and cervical HIV-1 shedding, even after controlling for the plasma HIV-1 load and the CD4 count. Vitamin A supplementation is unlikely to decrease HSV shedding and infectivity.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The synergy between herpes simplex virus type 2 (HSV-2) and human immunodeficiency virus type 1 (HIV-1) is well known, but lack of knowledge about the epidemiology of HSV-2 acquisition in HIV-1-discordant couples hampers development of HSV-2 prevention interventions that could reduce HIV-1 transmission.Methods: HIV-1-discordant couples were enrolled in Nairobi, Kenya and followed for up to 2 years. HSV-2 status was determined using HerpeSelect HSV-2 ELISA. Correlates of prevalence and incidence were assessed.Results: Of 469 HIV-1-discordant couples, at baseline, 353 (75.3%) were affected by HSV-2, of which 189 (53.5%) were concordantly HSV-2 seropositive and 164 (46.5%) were HSV-2-discordant. Prevalence was lowest among HIV-1-uninfected men (39.9%) compared to HIV-1-infected women (64.8%), HIV-1-infected men (66.7%), and HIV-1-uninfected women (68.5%). During follow-up, HSV-2 seroincidence was 14.9 per 100 person-years. Incidence was 1.6-fold higher among females compared to males (95% CI, 1.00-2.48) and 2.5-fold higher in HIV-1-infected compared to uninfected women (95% CI, 1.12-5.74). At least 30% of incident HSV-2 infections originated from an outside partner.Conclusions: The high HSV-2 prevalence and incidence in HIV-1-discordant couples in sub-Saharan Africa, suggest HSV-2 treatment and prevention could be an effective targeted strategy to reduce HSV-2 and HIV-1 transmission in this high-risk population.
    The Journal of Infectious Diseases 07/2013; 208(7). DOI:10.1093/infdis/jit303 · 5.78 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The epidemiology of genital herpes is changing. The seroprevalence of HSV-2 infections is increasing, while HSV-1 is an increasingly common cause of herpetic ulcerations. The reference examination provides direct diagnosis after viral isolation in a cell culture or genome amplification. Herpes serology is indicated principally if direct examination is negative and in the absence of lesions. Non-type-specific serology detects antibodies common to HSV-1 and HSV-2. Its specificity and sensitivity are excellent, and it is approved as a reimbursable laboratory procedure. It cannot specify the viral type involved. Type-specific serology can distinguish between anti-HSV-1 and anti-HSV-2 antibodies. Currently available kits have a sensitivity and specificity, depending on the population studied, of 90 to 100%. It is not approved as a reimbursable laboratory procedure. HSV-1-specific serology cannot diagnose old HSV-1 genital infections, but seropositivity for HSV-2 generally suffices to diagnose HSV-2 genital herpes. The indication for type-specific serology must be discussed according to clinical context. The value of non-type-specific serology is limited.
    La Presse Médicale 09/2008; 37(9):1251-1260. DOI:10.1016/j.lpm.2007.07.008 · 1.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background. HIV-infected (HIV+) men are more susceptible to sexually transmitted infections (STIs), and may also become superinfected by HIV. We hypothesized that HIV induces immune alterations in the foreskin that may impact the subsequent acquisition/clearance of genital co-infections.Methods. Foreskin tissue and blood were obtained from 70 HIV-uninfected and 20 HIV+ men undergoing elective circumcision. Tissue and blood T cells were characterized by flow cytometry, immunohistochemistry, and PCR.Results. There was substantial influx of CD8 T cells into the foreskins of HIV+ men (108.8 vs. 23.1 cells/mm(2), p<0.001); but foreskin CD4 T cell density was unchanged (43.0 vs. 33.7/mm(2), p=0.67), despite substantial blood depletion (409.0 vs. 877.8 cells/mm(3), p<0.001). While frequencies of foreskin CCR5+ T cells, Tregs and Th17 cells were unaltered in HIV+ men; CD8 T cell production of TNFα was decreased. HIV-specific CD8 T cells were present in the foreskins of HIV+ men, although their frequency and function was reduced compared to the blood.Conclusions. Foreskin CD4 T cell density and CCR5 expression were not reduced during HIV infection, perhaps explaining susceptibility to HIV superinfection. Foreskin CD8 T cell density was increased, but decreased production of TNFα may enhance susceptibility to foreskin-acquired genital co-infections in HIV+ men.
    The Journal of Infectious Diseases 11/2013; · 5.78 Impact Factor