and factors associated with herpes simplex
virus type 2 (HSV-2) infection in African-Caribbean women in Toronto, Canada
R. Kaul1, L. Chieza2, A. Rebbapragada3, M. Loutfy1, W. Tharao2, M. Saunders2, S. Huibner1, J. Liu1, L.-A. Green-Walker2, R. Remis1
1University of Toronto, Toronto, Canada, 2Women's Health in Women's Hands, Toronto, Canada, 3Ontario Agency for Health Protection and Promotion, Toronto, Canada
by HSV-2 has been associated with incident and prevalent HIV infection, as well
as with other genital co-infections. The
prevalence of HSV-2 infection is much higher
in HIV-endemic countries in sub-Saharan Africa and the
Caribbean than in Canada. We examined the
prevalence and factors associated with HSV-2 infection in HIV-infected and
uninfected African-Caribbean (AC) women from Toronto, Canada.
plan to enroll 600 participants, half HIV-infected,
through the Women's Health in Women's Hands Health Centre. A detailed
socio-behavioural ACASI questionnaire is administered. We
perform serologic testing for HSV-1/2, CMV, hepatitis, syphilis and HIV and
collected self-administered vaginal and anal swabs
for Gram stain, anal PAP and HPV testing.
Results: The present
analysis included the first 324 women recruited: 230 were HIV-uninfected
and 94 HIV-infected. The prevalence of CMV and
HSV-1 infection was high (97.2% and 89.4%, respectively) and did not vary with
HIV infection status. HSV-2 infection was also common and was more prevalent in
HIV-infected women (83.5% vs 53.7%; p< 0.0001).
We observed a strong age effect in
HIV-uninfected women, with HSV-2 prevalence increasing from 26% in
15-19 year olds to 80% in >60
year olds (p< 0.001). However,
no age trend was seen in HIV-infected women.
HSV-2 infection was strongly associated with bacterial vaginosis (p=0.007) and
also with increased vaginal infection by high-risk HPV strains (p=0.023). Among
HIV-uninfected women, HSV-2 prevalence tended to be lower in Canadian-born
women (36.7%) than those from Africa (56.3%) or the Caribbean (54.6%).
Conclusions: HSV-1 and CMV were highly
prevalent in both HIV-infected and uninfected AC women living in Toronto. HSV-2
prevalence in AC women from Toronto iswas
higher than reported in previous North American studies. The strong association
with HIV infection, regardless of age, suggests that HSV-2 infection may serve
as an important risk factor for HIV acquisition in this community.
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