Journal Dermatology
Journal Dermatology
Journal Dermatology
Advances in Virology
Volume 2015, Article ID 537939, 7 pages
http://dx.doi.org/10.1155/2015/537939
Research Article
Seroprevalence of Herpes Simplex Virus
Infection in HIV Coinfected Individuals in
Eastern India with Risk Factor Analysis
Copyright 2015 Soumyabrata Nag et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Herpes simplex virus type 2 (HSV-2) is the cause of most genital herpes while HSV-1 is responsible for orolabial and facial lesions. In
immunocompromised individuals, like HIV patients, impaired immunity leads to more frequent symptomatic and asymptomatic
HSV infection. Fifty-two blood samples from HIV patients with clinically diagnosed HSV infection were taken as cases, while 45
blood samples each from HIV-infected (HIV control) and noninfected patients without any herpetic lesion (non-HIV control)
were taken as control. Serum was tested for IgM and IgG antibodies of both HSV-1 and HSV-2 by ELISA. The seroprevalence was
compared among the three groups of study population, considering the demographic and socioeconomic parameters. The HSV-2
IgM was significantly higher ( < 0.005) in the HIV patient group (34.6%) than the HIV control (2.2%) and non-HIV control
(2.2%) groups, whereas HSV-2 IgG seroprevalence was higher in both HIV patient (61.5%) and HIV control (57.8%) groups than
the non-HIV control group (17.8%). The prevalence of HSV-2 was significantly higher in persons with multiple partners and in the
reproductive age group. The overall seroprevalence of HSV-1 IgM was too low (<5%), whereas it was too high (about 90%) with
HSV-1 IgG in all three study groups.
drugs, and inhibitors of the HSV helicase-primase are in 94.20% 93.30% 88.80%
the developmental stages. It is increasingly evident that
HSV-2 facilitates HIV transmission [5, 6] which strengthens
the importance of the implementation of available HSV
control methods [79]. The majority of HSV infections are
asymptomatic or silent and thus, the infected people shedding 3.80% 4.40% 2.20%
the virus are potentially infectious. Therefore, seroepidemi-
ological studies are critical to understand the pattern and HSV-1 HSV-1 IgG HSV-1 HSV-1IgG HSV-1 HSV-1 IgG
distribution of infection within populations [9]. IgM (HIV (HIV pt.) IgM (HIVc) IgM (Non- (Non-
pt.) (HIVc) HIVc) HIVc)
Till date, a limited amount of data on the HSV prevalence
and its association with HIV infection are available in Eastern Figure 1: Prevalence of HSV-1 IgM and IgG in HIV pt., HIVc, and
India, particularly in West Bengal. Hence, the aim of this non-HIVc group.
study was to find out the prevalence of HSV infection in
HIV patients attending the HIV Clinic of Medical College
61.50%
and Hospital, Kolkata. Specifically, we sought to know the 57.80%
prevalence of HSV-1 and HSV-2 antibodies (both IgM and
IgG) in HIV patients with herpetic blister and/or ulcer (HIV 34.60%
group), compared to that in both HIV and non-HIV patients 17.80%
without any herpetic blister and/or ulcer (HIV control) and 2.20% 2.20%
non-HIV control group. Moreover, the associations, if any,
with various demographic, socioeconomic, and behavioral HSV-2 HSV-2 IgG HSV-2 HSV-2IgG HSV-2 HSV-2 IgG
factors were correlated. IgM (HIV (HIV pt.) IgM (HIVc) IgM (Non- (Non-HIVc)
pt.) (HIVc) HIVc)
Figure 2: Prevalence of HSV-2 IgM and IgG in HIV pt., HIVc, and
2. Methods non-HIVc group.
On the other hand, HSV-2 IgM seroprevalence was 95% confidence interval 7.495157.895) more likely to be
significantly higher ( value < 0.005 by 2 test) in the HIV seropositive for HSV-2 IgG, significant at 5% level ( value <
patient group (34.6%) than the HIV control (2.2%) and non- 0.005). However, HSV-2 IgG did not vary significantly among
HIV control (2.2%) group (Tables 3 and 4). In comparison patients of different age groups, sex, socioeconomic strata,
to the non-HIV control group, sera from HIV patients and literacy levels but varied significantly with the number of
were 23 times more reactive for HSV-2 IgM (odds ratio partners among the patients of the HIV-patient and the non-
23.294; 95% confidence interval 2.961183.278). Further, the HIV control group ( value < 0.05).
seroprevalence was found to be higher in males of 1825 years
having more than one partner, literate, and in the upper lower 4. Discussion
socioeconomic class (Table 3).
HSV-2 IgG seroprevalence was higher in both HIV HSV infection is highly prevalent worldwide and varies
patient (61.53%) and HIV control (57.78%) groups than the between regions and populations.
non-HIV control group (17.78%). When compared with the In this study, it was found that the overall seroprevalence
non-HIV control group, the HIV patient group was 29 times of HSV-2 IgG was 42.3%. While it was 59.79% in HIV-
(odds ratio 29.421; 95% confidence interval 6.331136.720) infected patients (61.53% in case and 57.7% in control), and
and the HIV control group was 34 times (odds ratio 34.400; only 17.78% in the non-HIV group. However, higher rates of
4 Advances in Virology
coinfection with HIV and HSV-2 ranging from 62.7100% In our study, the seroprevalence of HSV-1 IgG was found
[1012], 88% and 91% [13] have been reported in the US, to be very high in all the study groups (overall 92.3%),
Haiti, and Central African Republic, respectively, which was showing a good correlation with the German study, where
similar to the control group of this study. Another study on the prevalence of HSV-I antibodies showed a steady increase
hospitalized patients and blood donors in Germany revealed with age and reached high levels (88%) among patients aged
overall 12.8% HSV-2 seropositivity, including 15% females 40 years or older [15]. In the German study, the seropositivity
and 10.5% males, but the prevalence in non-HIV control of HSV-1 (91.1%) and HSV-2 (47.9%) in HIV-infected popu-
group was 17.78% (20% in males and 15% in females) [14]. lations supports our observation of 93.81% and 59.79% in the
There are several possible biological mechanisms where present study. However, the higher seropositivity of HSV-2 in
HSV-2 acts as a cofactor in HIV acquisition or transmission. males in this study was probably due to limited sample size.
First, the HSV-2 reactivations result in mucosal or epithelial Higher prevalence of HSV-1 antibodies (73.3%) among 168
disruption, creating a portal of exit or entry for HIV, to HIV-antibody negative and 132 HIV-antibody positive men,
which the activated CD4 cells are recruited [14]. There also with no difference between HIV seronegative and seroposi-
appear to be several cellular interactions that promote the tive men ( value = 0.48), while about 20% of HIVseronega-
establishment of HIV infection and its coinfection with HSV- tive and 61% of seropositive men showed antibodies to HSV-
2 which may lead to the creation of pseudotypes (i.e., HSV- 2 ( < 0.0001). Similarly, 83.5% and 63.4% seroprevalence
2 particles containing the HIV genome enveloped with HSV of HSV-1 and HSV-2 among patients at higher risk for HIV
surface glycoprotein). This allows HSV to infect the cells that reported by Lupi [17], is similar to the findings in this study.
could not be infected by HIV alone [11]. The HSV-2 infection The present cross-sectional study on seroprevalence of
may also promote the increased expression of the HIV target HSV-2 corroborated the prospective observational study of
cells (i.e., the CCR5+ CD4 cells and the immature dendritic Patel et al. [18]. Similar results on the seroprevalence of HSV-
cells) [12]. 2 in adult HIV-infected patients and blood donors were also
Advances in Virology 5
Table 4: Seroprevalence of HSV-1 and 2 antibodies (IgM and IgG) in different study groups.
HIV patient group HIV control group Non-HIV control group Total Chi square test
R NR T R NR T R NR T R NR T ( value)
0.838
HSV1 2 50 52 2 43 45 44 45 137 142
1 (2.2%) 5 (3.5%) (not statistically
IgM (3.8%) (96.2%) (100%) (4.4%) (95.6%) (100%) (97.8%) (100%) (96.5%) (100%)
significant)
0.585
HSV1 49 3 52 42 3 45 40 45 131 142
5 (11.1%) 11 (7.7%) (not statistically
IgG (94.2%) (5.8%) (100%) (93.3%) (6.7%) (100%) (88.9%) (100%) (92.3%) (100%)
significant)
0.000
HSV2 18 34 52 1 44 45 44 45 20 122 142
1 (2.2%) (statistically
IgM (34.6%) (65.4%) (100%) (2.2%) (97.8%) (100%) (97.8%) (100%) (14.1%) (85.9%) (100%)
significant)
0.000
HSV2 32 20 52 26 19 45 8 37 45 66 76 142
(statistically
IgG (61.5%) (38.5%) (100%) (57.8%) (42.2%) (100%) (17.78%) (82.22%) (100%) (46.48%) (53.52%) (100%)
significant)
6 Advances in Virology
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Conflict of Interests Journal of Clinical and Diagnostic Research, vol. 5, no. 6, pp.
11901194, 2012.
The authors declare that they have no conflict of interests [15] P. Wutzler, H. W. Doerr, I. Farber et al., Seroprevalence of
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