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BMC Infectious Diseases

, 13:502

HIV and co-infections

Abstract

BackgroundHerpes simplex virus type 2 HSV-2 is a common co-infection among HIV-infected adults that is hypothesized to accelerate HIV disease progression.

MethodsWe searched Medline, EMBASE, relevant conference proceedings 2006–12 and bibliographies of identified studies without language restriction for cohort studies examining the impact of HSV-2 on highly active antiretroviral therapy-untreated HIV disease in adults. The exposure of interest was HSV-2 seropositivity or clinical-laboratory markers of HSV-2 activity. The primary outcome was HIV disease progression, defined as antiretroviral initiation, development of AIDS-opportunistic infection, or progression to CD4 count thresholds ≤200 or ≤350 cells-mm. Secondary outcomes included HIV plasma viral load and CD4 count.

ResultsSeven studies were included. No definitive relationship was observed between HSV-2 seropositivity and time to antiretroviral initiation n=2 studies, CD4≤350 n=1, CD4≤200 n=1, death n=1, viral load n=6 or CD4 count n=3. Although two studies each observed trends towards accelerated progression to clinical AIDS-opportunistic infection in HSV-2 seropositives, with pooled unadjusted hazard ratio=1.85 95% CI=1.12,3.06; I=2%, most OIs observed in the study for which data were available can occur at high CD4 counts and may not represent HIV progression. In contrast, a single study HSV-2 disease activity found that the presence of genital HSV-2 DNA was associated with a 0.4 log copies-mL increase in HIV viral load.

ConclusionsDespite an observation that HSV-2 activity is associated with increased HIV viral load, definitive evidence linking HSV-2 seropositivity to accelerated HIV disease progression is lacking. The attenuating effects of acyclovir on HIV disease progression observed in recent trials may result both from direct anti-HIV activity as well as from indirect benefits of HSV-2 suppression.

KeywordsHerpes simplex virus Human immunodeficiency virus Disease progression Viral load CD4 count Seropositivity Systematic review Electronic supplementary materialThe online version of this article doi:10.1186-1471-2334-13-502 contains supplementary material, which is available to authorized users.

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Autor: Darrell Hoi-San Tan - Kellie Murphy - Prakesh Shah - Sharon Lynn Walmsley

Fuente: https://link.springer.com/







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