INCREASED GENITAL SHEDDING OF HERPES-SIMPLEX VIRUS TYPE-2 IN HIV-SEROPOSITIVE WOMEN

Objective: To compare the prevalence of genital herpes simplex virus t ype 2 (HSV-2) shedding in human immunodeficiency virus (HIV)-seroposit ive women and HIV-seronegative women. Design: Cross-sectional study Se tting: A major inner-city medical center. Patients: 106 women who were HIV-seropositive and HSV-2-seropositive and 70 women who were HIV-ser onegative and HSV-2-seropositive were enrolled from various primary ca re settings. Measurements: Herpes simplex virus type 2 antibody determ inations were done for all patients. Regardless of symptoms, vulvar an d cervical HSV cultures were obtained from all HIV-seropositive women and from a randomly selected subgroup of HIV-seronegative women. Resul ts: The prevalence of HSV-2 shedding was nearly four times greater in HIV-seropositive than in HIV-seronegative women (13.2% compared with 3 .6%; P = 0.04; odds ratio, 4.1 [95% CI, 1.0 to 27.4]) when the serum a ntibody for HSV-2 was present. Seventy-nine percent of viral shedding among HIV-seropositive women was asymptomatic. Overall viral shedding increased significantly as the CD4 cell count decreased. Conclusions: Women with HIV infection, particularly those with low CD4 cell counts, shed HSV-2 from the vulva and cervix more commonly than women not inf ected with HIV. Most of this shedding is asymptomatic.