Much of HIV Transmission Driven By Herpes Co-Infection

Dr. Don C. Des Jarlais PhD Director, International Research Core, Center for Drug Use and HIV Research Research Fellow, NDRI Director of Research, Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center Professor of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of MedicineMedicalResearch Interview with:
Dr. Don C. Des Jarlais PhD
Director, International Research Core, Center for Drug Use and HIV Research
Research Fellow, NDRI
Director of Research, Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center
Professor of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine

Medical Research: What are the main findings of the study?

Dr. Des Jarlais: HIV infection among non-injecting users of heroin and cocaine doubled doubled over the last several decades, from 7% to 14%. Herpes simplex virus type 2 (HSV-2) increases both susceptibility to and transmissibility of HIV. We examined HSV-2 infection among non-injecting heroin and cocaine user over the same time period using stored serum samples. HSV-2 infection was strongly related to HIV infection, and both increased over time. We calculated population attributable risk percentages (PAR%) to estimate the extent to which HSV-2 was driving increased HIV infection. HSV-2 infection was responsible for approximately half of the increase in HIV infection

Medical Research: Were any of the findings unexpected?

Dr. Des Jarlais: It is well known that HSV-2 infection increases HIV transmission, but it was surprising to see this large an effect. This is similar to what has happened with HSV-2 and HIV in sub-Saharan Africa.

Medical Research: What should clinicians and patients take away from your report?

Dr. Des Jarlais: It is critical that persons infected with both HIV and HSV-2 should go on anti-retroviral treatment and use condoms so that they do not transmit HIV to others.
Persons who are infected with HSV-2 and engaging in behavior that puts them at high risk for acquiring HIV should use condoms consistently and also consider pre-exposure prophylaxis (PrEP) to avoid becoming infected with HIV.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Des Jarlais: If we are going to have an “AIDS free generation” in the US, we will need to focus additional prevention efforts on persons with HSV-2 infection. How to reach these persons and best enroll them in treatment and prevention services are urgent research questions. This applies to men-who-have sex with men also.

Citation:

HSV-2 Co-Infection as a Driver of HIV Transmission among Heterosexual Non-Injecting Drug Users in New York City

Don C. Des Jarlais, Kamyar Arasteh, Courtney McKnight, David C. Perlman, Jonathan Feelemyer, Holly Hagan, Hannah L. F. Cooper

Published: January 31, 2014 DOI: 10.1371/journal.pone.0087993

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