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Higher Rectal HIV RNA Levels in Men who have Sex with Men (MSM) with Concurrent Rectal HSV Shedding
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IDSA Conference, Infectious Disease Society, Toronto, Oct 12-15, 2006
NINA KIM, MD1, ALDO LUCCHETTI, MD2, WILLIAM WHITTINGTON, PhD1, RICHARD ZUCKERMAN, MD3, ROBERT COOMBS, MD1, LAWRENCE COREY, MD1, JORGE SANCHEZ, MD2, CONNIE CELUM, MD1;
1Univ of Washington, Seattle, WA,2Impacta, Lima, Peru,3Dartmouth College, Hanover, NH.
Abstract:
Background HSV-2 infection may increase the risk of HIV transmission by increasing HIV shedding during reactivation. Plasma HIV RNA levels & concomitant rectal mucosal HIV RNA & HSV DNA were studied in MSM with recent or established HIV infection.
Methods In Lima, Peru, MSM recently infected with HIV-1 (based on reactive EIA with negative EIA in prior 3 months) & chronically HIV-infected MSM not on ART were assessed for HIV levels in blood & rectal Sno-strips, & HSV levels in rectal swabs over 2-4 visits. Rectal HIV RNA & HSV DNA were quantified by RT-PCR; lower limits of detection were 3.9 & 2.7 log10 copies/ml respectively. Generalized estimating equations (GEE) were used.
Results
6 newly HIV-infected (median 4 months) MSM with median CD4 count 663/ml (range 354-848) and 17 chronically infected MSM with median CD4 count 352/ml (202-1105) were studied.
HIV RNA was detected in >90% of rectal samples overall & did not differ significantly between men with early & established HIV infection.
Median baseline HIV RNA levels were higher in rectal secretions than in plasma in both early (4.9/4.3 log10 copies/ml) & established infections (5.6/4.3 log10 copies/ml, P<0.05, each comparison).
HSV DNA was detected in 3/13 (23%) and 10/38 (26%) rectal swabs of all 23 MSM with early & established HIV infection, respectively.
In GEE, concurrent HSV rectal shedding was associated with higher rectal (.48 log10 copy/ml, 95%CI .01-.95, P=.047) & plasma HIV RNA (.41 log10 copy/ml, 95% CI .11-.72, P=.008), adjusting for CD4 count.
A 10-fold increase in rectal HSV DNA quantity was associated with 13.8-fold higher rectal HIV-1 RNA levels (95% CI 10.2-19, P=.04).
Conclusion Among MSM with early & chronic HIV infection, rectal HSV shedding was associated with higher rectal & plasma HIV-1 RNA levels. There was a dose-response relationship between rectal HSV & HIV-1 levels. HSV-2 reactivation may thus increase HIV-1 infectiousness and disease progression
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