Herpes simplex virus type 2 and syphilis infections with HIV: An evolving synergy in transmission and prevention

Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, USA.
Current opinion in HIV and AIDS (Impact Factor: 4.68). 08/2009; 4(4):294-9. DOI: 10.1097/COH.0b013e32832c1881
Source: PubMed


Herpes simplex virus type 2 (HSV-2) and syphilis are associated with HIV infection. The purpose of this review is to summarize the advances in the relationship of HSV-2 and syphilis with HIV, highlighting intervention trials to prevent HIV acquisition and transmission.
HIV acquisition has often been linked to genital ulcers due to HSV-2 and syphilis. The latest pathophysiological studies have continued to elucidate the relationship between HSV-2, syphilis and HIV, establishing that both syphilitic and HSV-2-infected tissue have increased numbers of chemokine receptor 5-expressing T cells, and several models have further emphasized the viral synergy between HSV-2 and HIV. In clinical trials, HSV suppressive therapy decreased HIV RNA levels that might affect transmission, but two trials have failed to prevent HIV acquisition. Male circumcision, however, prevents both HIV and HSV-2 acquisition.
Genital ulcers from HSV-2 and syphilis are associated with HIV acquisition. The exact role for these HIV cofactors is still unknown and exemplified by the failure of HSV suppressive therapy to decrease HIV acquisition. Male circumcision, however, reduces HSV-2 acquisition. With several HSV suppressive trials to prevent HIV transmission and disease progression currently ongoing, the future promises to provide more critical information for the control of HIV infection.

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    • "statistics amongst 2700 co-habiting couples has shown that in 79% of the cases both partners are HIV sero-negative[2]whilst in 10% of the couples both partners are HIV sero-positive. Interestingly, 11 % of couples are discordant, that is, one partner is infected with HIV and the other is not[2].Thus, sexual contact with an HIV infected person represents only a necessary, but not sufficient, condition for HIV transmission through sex suggesting that other cofactors may be central in fueling the HIV epidemic.Studies have observed a synergistic relationship between HIV and co-infections including other environmental factors that could be possible cofactors for HIV-1 acquisition and/ or transmission[42,43,44,45] "

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    • "The added important finding of this trial was the absence of viral resistance, its safety and more importantly, the effectiveness of tenofovir gel to reduce the acquisition of HSV-2 infections by 51%. This finding is important as the risk of HIV acquisition increases to a large extent in women who are HSV-2 infected (Tobian & Quinn, 2009; Wald & Link, 2002). "

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