Prevalence and Characteristics of Herpes Simplex Virus Type-2 Coinfection in Veterans With Hepatitis C
and Departments of Medicine and Infectious Disease (EWH), University of Alabama at Birmingham, Birmingham, Alabama.The American Journal of the Medical Sciences (Impact Factor: 1.39). 03/2012; 344(6). DOI: 10.1097/MAJ.0b013e31824585bd
INTRODUCTION: Epidemiologic links between herpes simplex virus type-2 (HSV-2) and hepatitis C virus (HCV) exist but are poorly characterized. Seroprevalence studies of HSV-2 in veteran populations with chronic HCV infection are lacking. METHODS: The authors reviewed the medical histories and results of the HerpeSelect IgG (Focus Diagnostics, Cypress, CA) of 244 HCV-infected male veterans engaged in care. All patients were human immunodeficiency virus negative and >99% defined themselves as heterosexual. RESULTS: Using the manufacturer's recommended cutoff for positive results (>1.1), 51.5% of HCV-infected veterans were seropositive for HSV-2. When increasing the cutoff to >3.5, 38.7% of persons were seropositive for HSV-2. Reports of previous diagnosis with genital ulcer disease (9/213; 4.3%) or genital herpes (4/213; 1.9%) were rare. CONCLUSIONS: HSV-2 infection commonly occurred in the study sample of HCV-infected veterans but was infrequently recognized. Future studies should optimize the use of type-specific serologic screening tests in HCV-infected persons. The high prevalence of HSV-2 in this population merits further investigation into any potential biologic interactions between these common viral infections.
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ABSTRACT: Introduction: We performed a pilot study examining the safety and tolerability of valacyclovir in veterans with herpes simplex virus type 2 and hepatitis C virus (HCV) coinfection. Methods: We performed a randomized double-blind, placebo-controlled, crossover clinical trial in U.S. veterans with genotype 1 HCV/herpes simplex virus type 2 coinfection. Patients were randomized 1:1 in blocks of 10 to receive either 1 g twice-daily valacyclovir or matching placebo for 8 weeks followed by a 2-week washout phase with daily placebo. The alternate therapy (valacyclovir or placebo) was given for an additional 8-week period. Safety assessments were performed every 2 weeks. Changes in HCV RNA and alanine aminotransferase (ALT) were estimated using linear mixed models (SAS Proc Mixed). Results: Thirty patients were enrolled. Valacyclovir was not associated with toxicity or adverse events. ALT levels declined 6% to 10%; mean HCV RNA levels were reduced 24% (1.3 million IU/mL [0.21 log10 IU/mL]) during the valacyclovir phase (P = 0.08) with no carryover effect observed (P = 0.21). Conclusions: Valacyclovir 1 g twice daily showed no evidence of hepatotoxicity in U.S. veterans with hepatitis C. A modest reduction in serum levels of ALT and plasma levels of HCV RNA was observed.
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ABSTRACT: Epidemiologic links between chronic hepatitis C and herpes simplex type-2 infection have been suggested; however, type-specific tests for HSV-2 infection have not been validated in patients with chronic hepatitis C infection. The Focus HerpeSelect(®) HSV-2 IgG (Cypress, California) assay and the Biokit HSV-2 rapid assay (Biokit USA, Lexington, MA) were performed on serum samples obtained from 84 veterans with chronic hepatitis C who demonstrated a previously positive HSV-2 serologic test in their medical records. Using the Biokit HSV-2 as the comparator assay, the positive predictive value, and specificity for the HerpeSelect(®) HSV-2 assay were 62.1% (95%CI: 49.3-73.8) and 41.9% (95%CI: 27.0-57.9), respectively. Increasing the HerpeSelect(®) HSV-2 index value defining a positive test result from >1.1 to ≥2.89 increased the assay's specificity to 97.7% (95%CI: 87.7-99.6) and the positive predictive value to 94.1%(95%CI: 71.2-99.0). J. Med. Virol. 9999: 1-5, 2015. © 2015 Wiley Periodicals, Inc. In veterans with chronic hepatitis C infection, HerpeSelect(®) HSV-2 index values between 1.1 and 2.89 should be confirmed with an alternate test for HSV-2 infection. © 2015 Wiley Periodicals, Inc.
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