Human immunodeficiency virus acquisition associated with genital ulcer disease and herpes simplex virus type 2 infection: A nested case-control study in Rakai, Uganda

To assess the timing of symptomatic genital ulcer disease ( GUD) relative to human immunodeficiency virus ( HIV) seroconversion, we studied 248 case subjects who underwent HIV seroconversion and 496 HIV- negative control subjects, at 3 interview visits conducted at 10- month intervals: visit 1, before HIV acquisition; visit 2, after seroconversion; and visit 3, 10 months after detection of seroconversion. Odds ratios ( ORs) and 95% confidence intervals ( CIs), for HIV acquisition, were estimated by logistic regression. HIV load was measured by RNA - polymerase chain reaction, and herpes simplex virus type 2 ( HSV- 2) serologic testing used HerpeSelect EIA with Western blot confirmation. The OR of HSV- 2 seropositivity associated with HIV acquisition was 1.7 ( 95% CI, 1.2 - 2.4). Prevalence of GUD was increased among case subjects, at visits 2 ( OR, 3.2; 95% CI, 1.9 - 5.3) and 3 ( OR, 2.1; 95% CI, 1.1 - 3.9). HIV load was increased in HSV- 2 - seropositive case subjects, compared with that in HSV- 2 - seronegative subjects, at 5 ( p = .04) and 15 (P = .02) months after seroconversion. HIV acquisition is associated with HSV- 2 seropositivity, and GUD is increased after seroconversion. HIV load is increased in HSV- 2 - positive subjects who seroconverted, suggesting a role for treatment of HSV- 2 infection in HSV- 2 - seropositive, dually infected individuals.