234. The Epidemiology and Risk factors Associated with Herpes Simplex Virus [HSV]-2 infections in a Large Well-Characterized Cohort of HIV infected patients- 2006-2014
Session: Poster Abstract Session: Diagnostics: Virology
Thursday, October 8, 2015
Room: Poster Hall
Background:

Genital ulcers due to HSV-2 double the risk of HIV acquisition and HSV-2 infection may accelerate disease course in HIV-infected individuals. Given the strong synergistic relationship of these infections, we examined the incidence, prevalence, and risk factors associated with HSV-2 infection in the US Military HIV Natural History Study (NHS). NHS subjects have unrestricted access to care, are predominantly male and possess at a minimum a high school or equivalent degree.

Methods:

Subjects enrolled in the NHS, were eligible if they contributed person time between 2006 and 2014, and had results of HSV-2 testing recorded.  We examined demographic (gender, age, race, marital status, rank), HIV-specific [CD4 count, viral load, anti-retroviral therapy (ART) use], and behavioral factors [sexually transmitted infection (STI) history and erectile dysfunction drug use] using a logistic regression model for the prevalence estimates and a Cox proportional hazard model to analyze incidence.  Odds Ratios and hazard ratios are presented with 95% confidence intervals.

Results:

Of the 2092 eligible subjects (94% male, median age 38, 43% African-American [AA], 40% Caucasian, 11% Hispanic), 961 (45%) had prevalent HSV-2.  In a multivariate model, increasing age [per year increase, 1.07 (1.06-1.08)]; female gender [1.95 (1.3-2.9)]; non-white race [AA- 2.9 (2.3-3.6); Hispanic, 1.5 (1.1-2.1)] were associated with prevalent HSV-2.  900 initially negative subjects had serial HSV-2 serologies and were included in the incidence analysis. 184 [98% male, median age 31, 43% AA, 38% Caucasian, 12% Hispanic] subjects seroconverted. In a multivariate analysis, younger age [per year increase, 0.94 (0.92- 0.95)]; higher viral load [per log increase, 1.3 (1.2-1.4)]; and prior STI [2.1 (0.35, 0.68)] were associated with incident disease.

Conclusion:

Prevalence of HSV-2 infection in the NHS is lower than estimates from civilian US HIV infected populations (~60%), favorable socio-demographic factors of the NHS may account for these differences. Similar to the civilian population, female gender and racial minority status are risk factors for prevalent HSV-2. Prevention messages that target younger HIV infected patients with prior STIs may reduce incident HSV-2 infections.

Michael Koren, MD1, Xun Wang, MS2,3, Jason Okulicz, MD, FIDSA2,4, Jason Blaylock, MD1, Timothy Whitman, DO5, Robert Deiss, MD2,6,7, Thomas O'bryan, MD2,4,7, Tahaniyat Lalani, MD3,8,9, Brian Agan, MD, FIDSA2,10, Grace E Macalino, PhD3,11 and Anuradha Ganesan, MD, MPH5,10,11, (1)Walter Reed Military Medical Center, Bethesda, MD, (2)Infectious Disease Clinical Research Program, USUHS, Rockville, MD, (3)The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, (4)San Antonio Military Medical Center, Fort Sam Houston, TX, (5)Walter Reed National Military Medical Center, Bethesda, MD, (6)Naval Medical Center San Diego, San Diego, CA, (7)Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, (8)Naval Medical Center, Portsmouth, VA, (9)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (10)Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, (11)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD

Disclosures:

M. Koren, None

X. Wang, None

J. Okulicz, None

J. Blaylock, None

T. Whitman, None

R. Deiss, None

T. O'bryan, None

T. Lalani, None

B. Agan, None

G. E. Macalino, None

A. Ganesan, None

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