Abstract

Prevalence 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. Remis<sup>1

1</sup>University of Toronto, Toronto, Canada, ²Women's Health in Women's Hands, Toronto, Canada, ³Ontario Agency for Health Protection and Promotion, Toronto, Canada

Background: Infection 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.
Methods: We 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.