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1.
J Infect Dis ; 219(12): 1940-1947, 2019 05 24.
Artículo en Inglés | MEDLINE | ID: mdl-30753642

RESUMEN

BACKGROUND: Genital infection with herpes simplex virus type 2 (HSV-2) is common and increases risk of human immunodeficiency virus (HIV) transmission and acquisition. Pericoital use of tenofovir (TFV) gel provided protection from HSV-2 acquisition in the CAPRISA 004 study. METHODS: We measured estimate of effect of vaginal TFV 1% gel in preventing HSV-2 acquisition among women in VOICE, randomized, double-blinded, placebo-controlled trial assessing daily use of oral and vaginal TFV for HIV-1 preexposure prophylaxis. The TFV level in plasma at the first quarterly visit was used as a measure of gel use. RESULTS: Of 566 participants at risk for HSV-2 acquisition, 532 (94%) had first-quarter plasma TFV and end-of-study HSV-2 serologic data available. Over a follow-up period of 501 person-years, 92 incident cases of HSV-2 acquisition occurred: 77 were in women with no TFV detected in plasma, and 15 occurred in women with TFV detected in plasma (incidence, 20.6 cases/100 person-years [95% confidence interval [CI], 16.2-25.7] vs 11.9 cases/100 person-years [95% CI, 6.6-19.6], respectively). TFV detection in plasma was associated with a trend toward a reduced risk of HSV-2 seroconversion, with an unadjusted hazard ratio (HR) of 0.59 (95% CI, .34-1.02; P = .060) and a HR adjusted for site, age, having ≥2 male sex partners in the past 3 months, use of hormonal contraception, having anal sex in the past 3 months, and HIV status of 0.60 (95% CI, .33-1.08; P = .086). CONCLUSIONS: Detection of TFV in plasma among TFV gel users was associated with a trend toward a reduced risk of HSV-2 acquisition, after controlling for sexual behavior and HIV-1 acquisition.


Asunto(s)
Antivirales/uso terapéutico , Herpes Genital/prevención & control , Herpesvirus Humano 2/efectos de los fármacos , Tenofovir/uso terapéutico , Cremas, Espumas y Geles Vaginales/uso terapéutico , Adolescente , Adulto , Método Doble Ciego , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/virología , VIH-1 , Herpes Genital/virología , Humanos , Incidencia , Profilaxis Pre-Exposición/métodos , Conducta Sexual , Adulto Joven
3.
J Infect Dis ; 214(1): 36-44, 2016 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-26917575

RESUMEN

BACKGROUND: Human herpesvirus (HHV) infections are common during infancy. Primary infections are frequently asymptomatic and best studied prospectively by using direct viral detection. METHODS: Oropharyngeal swab specimens were collected weekly from Ugandan newborn infants, their mothers, and other children in the household. Blood specimens were collected every 4 months. Samples were tested for herpes simplex virus (HSV) types 1 and 2, Epstein-Barr virus (EBV), cytomegalovirus (CMV), HHV-6A, HHV-6B, and HHV-8, using quantitative polymerase chain reaction. RESULTS: Thirty-two infants, 32 mothers, and 49 other household children were followed for a median of 57 weeks. Seventeen mothers had human immunodeficiency virus type 1 (HIV) infection; no infants acquired HIV-1. The 12-month incidence of postnatal infection was 76% for HHV-6B, 59% for CMV, 47% for EBV, 8% for HSV-1, and 0% for HHV-8. The quantity of oropharyngeal shedding by contacts was associated with HHV-6A or HHV-6B transmission. Maternal HIV-1 infection was associated with EBV transmission, while breastfeeding and younger child contacts were associated with CMV transmission. Except for HSV-1, primary HHV infections were subclinical. CONCLUSIONS: By capturing exposures and acquisition events, we found that the incidence and risk factors of infection vary by HHV type. HSV-1 infection, unlike other HHV infections, caused acute clinical illness in these infants.


Asunto(s)
Infecciones por Herpesviridae/sangre , Infecciones por Herpesviridae/transmisión , Herpesviridae/aislamiento & purificación , Adolescente , Adulto , Niño , Preescolar , Estudios de Cohortes , Femenino , Infecciones por Herpesviridae/epidemiología , Infecciones por Herpesviridae/fisiopatología , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Uganda/epidemiología
4.
BMC Infect Dis ; 15: 398, 2015 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-26423888

RESUMEN

BACKGROUND: The commercial Kalon HSV-2 IgG ELISA is currently recommended for research use in sub-Saharan Africa because of its superior accuracy compared to other serologic assays. However, there are no data on key precision parameters of Kalon such as inter-operator variation, repeatability, and reproducibility, thus contributing to a barrier for its acceptance and use in clinical trials in sub-Saharan Africa. We evaluated the analytical and field precision of the Kalon HSV-2 IgG ELISA. METHODS: A total of 600 HIV-infected and uninfected serum samples from South Africa and Zambia, previously tested by the gold standard University of Washington HSV western blot (UW-WB), were tested using Kalon by two technologists in an United States reference laboratory. Aliquots of 183 samples were retested using Kalon by an on-site technologist in a South African laboratory and a Zambian laboratory. RESULTS: Intra-assay variation was below 10 %. Intra-assay, intra-laboratory, and inter-laboratory correlation and agreement were significantly high (p < 0.01). In comparison to the UW-WB, accurate performance of Kalon was reproducible by each operator and laboratory. Receiver operating characteristic curve analysis indicated high selectivity of Kalon in the overall study population (area under the curve = 0.95, 95%CI = 0.92-0.97). DISCUSSION: Kalon is a robust assay with high precision and reproducibility. Accordingly, operator errorlikely does not contribute to the variability observed in Kalon's specificity throughout sera from sub-Saharan Africa. CONCLUSIONS: In populations with optimal diagnostic accuracy, Kalon is a reliable stand-alone method for on-site HSV-2 IgG antibody detection.


Asunto(s)
Anticuerpos Antivirales/sangre , Ensayo de Inmunoadsorción Enzimática , Herpes Genital/diagnóstico , Herpesvirus Humano 2/inmunología , Inmunoglobulina G/sangre , Laboratorios/normas , Adulto , Área Bajo la Curva , Calibración , Ensayo de Inmunoadsorción Enzimática/normas , Femenino , Infecciones por VIH/complicaciones , Herpes Genital/complicaciones , Herpes Genital/virología , Humanos , Masculino , Curva ROC , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
5.
J Clin Virol ; 61(3): 378-81, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25200648

RESUMEN

BACKGROUND: HSV-2 diagnosis is typically by viral culture, viral DNA amplification of lesion material or by serology in cases of subclinical presentation. These methods can be time consuming and expensive. The Uni-Gold™ HSV-2 Rapid is a fast, point-of-care diagnostic test that can be performed outside a full service laboratory. OBJECTIVE: To evaluate the ability of the Uni-Gold™ HSV-2 Rapid to correctly diagnose the presence or absence of anti-HSV-2 antibodies in patient serum samples in comparison to the University of Washington HSV Western blot (UWWB). STUDY DESIGN: Sera from 100 adult patients in the USA were tested for HSV-2 specific antibodies by Uni-Gold™ HSV-2 Rapid and results were compared to those of the UWWB to determine the test's sensitivity and specificity. RESULTS: Of 18 patients seropositive for HSV-2 by UWWB, 17 were correctly identified as such by the Uni-Gold™ HSV-2 Rapid. Of 76 patients who were seronegative for HSV-2 by UWWB, 75 were correctly identified by the rapid test. Six sera had indeterminate results by UWWB. Sensitivity for the Uni-Gold™ HSV-2 Rapid was 94% and specificity was 99%. CONCLUSION: The Uni-Gold™ HSV-2 Rapid had high sensitivity and specificity in a small sample of unselected, adults seeking care in the Seattle, USA area. An accurate, near-person test allows immediate counseling directed toward symptom recognition, treatment, and practices that can limit the risk of HSV-2 transmission.


Asunto(s)
Anticuerpos Antivirales/sangre , Pruebas Diagnósticas de Rutina/métodos , Herpes Genital/diagnóstico , Herpesvirus Humano 2/inmunología , Sistemas de Atención de Punto , Adulto , Femenino , Humanos , Masculino , Sensibilidad y Especificidad , Washingtón
6.
J Infect Dis ; 208(9): 1366-74, 2013 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-23901094

RESUMEN

BACKGROUND: Daily suppressive therapy with valacyclovir reduces risk of sexual transmission of herpes simplex virus type 2 (HSV-2) in HSV-2-serodiscordant heterosexual couples by 48%. Whether suppressive therapy reduces HSV-2 transmission from persons coinfected with HSV-2 and human immunodeficiency virus type 1 (HIV-1) is unknown. METHODS: Within a randomized trial of daily acyclovir 400 mg twice daily in African HIV-1 serodiscordant couples, in which the HIV-1-infected partner was HSV-2 seropositive, we identified partnerships in which HIV-1-susceptible partners were HSV-2 seronegative to estimate the effect of acyclovir on risk of HSV-2 transmission. RESULTS: We randomly assigned 911 HSV-2/HIV-1-serodiscordant couples to daily receipt of acyclovir or placebo. We observed 68 HSV-2 seroconversions, 40 and 28 in acyclovir and placebo groups, respectively (HSV-2 incidence, 5.1 cases per 100 person-years; hazard ratio [HR], 1.35 [95% confidence interval, .83-2.20]; P = .22). Among HSV-2-susceptible women, vaginal drying practices (adjusted HR, 44.35; P = .004) and unprotected sex (adjusted HR, 9.91; P = .002) were significant risk factors for HSV-2 acquisition; having more children was protective (adjusted HR, 0.47 per additional child; P = .012). Among HSV-2-susceptible men, only age ≤30 years was associated with increased risk of HSV-2 acquisition (P = .016). CONCLUSIONS: Treatment of African HSV-2/HIV-1-infected persons with daily suppressive acyclovir did not decrease risk of HSV-2 transmission to susceptible partners. More-effective prevention strategies to reduce HSV-2 transmission from HIV-1-infected persons are needed.


Asunto(s)
Aciclovir/administración & dosificación , Antivirales/administración & dosificación , Coinfección/tratamiento farmacológico , Infecciones por VIH/tratamiento farmacológico , VIH-1 , Herpes Genital/prevención & control , Herpesvirus Humano 2/efectos de los fármacos , Adulto , Coinfección/epidemiología , Coinfección/virología , Esquema de Medicación , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , Herpes Genital/epidemiología , Herpes Genital/transmisión , Humanos , Incidencia , Estimación de Kaplan-Meier , Masculino , Análisis Multivariante , Modelos de Riesgos Proporcionales , Resultado del Tratamiento
7.
Sex Transm Infect ; 87(3): 238-41, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21307152

RESUMEN

OBJECTIVE: To compare the performance of the Focus HerpeSelect-2 enzyme immunoassay (EIA) with the gold standard herpes simplex virus (HSV) type 2 western blot, among HIV-1-uninfected men and women in east and southern Africa. METHODS: 3399 HIV-1-uninfected women and men from seven countries in east and southern Africa were tested for HSV-2 antibody using the Focus HerpeSelect-2 EIA. The performance of the HerpesSelect-2 EIA was compared with the gold standard HSV-2-specific western blot. RESULTS: Two-thirds (2294/3399) of participants were male and two-thirds (2242/3399) were from east Africa. By western blot testing, HSV-2 prevalence was 68%; 59% in men and 85% in women. At the manufacturer's recommended cut-off value of greater than 1.1, the HerpeSelect-2 EIA had a sensitivity of 98.3% and specificity of 80.3%. Receiver operating characteristic plot analysis indicated that the optimum cut-off was 2.1 or greater, with sensitivity 93.9% and specificity 90.5%. Diagnostic accuracy was modestly higher for southern Africa (area under the curve (AUC) 0.979, 95% CI 0.970 to 0.988) compared with east Africa (AUC 0.954, 95% CI 0.942 to 0.965; p<0.001 for southern vs east Africa). CONCLUSIONS: The Focus HerpeSelect-2 EIA has acceptable diagnostic accuracy for the determination of HSV-2 serostatus in African HIV-1-uninfected adults. An assay cut-off value of 2.1 or greater results in approximately 90% sensitivity and specificity, against a gold standard HSV-2 western blot. Diagnostic accuracy differed slightly by geographical region.


Asunto(s)
Anticuerpos Antivirales/sangre , Herpes Genital/diagnóstico , Herpesvirus Humano 2/inmunología , Técnicas para Inmunoenzimas/métodos , Adulto , África del Sur del Sahara , Anciano , Western Blotting , Estudios de Factibilidad , Femenino , Infecciones por VIH/complicaciones , Herpes Genital/complicaciones , Humanos , Técnicas para Inmunoenzimas/normas , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Adulto Joven
8.
Sex Transm Dis ; 38(2): 140-7, 2011 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-20706175

RESUMEN

BACKGROUND: Several commercial type-specific serologic tests are available for herpes simplex virus type 2 (HSV-2). Poor specificity of some tests has been reported on samples from sub-Saharan Africa. METHODS: To summarize the performance of the tests using samples from sub-Saharan Africa, we conducted a systematic review of publications reporting performance of commercially available HSV-2 tests against a gold standard (Western Blot or monoclonal antibody-blocking EIA). We used random-effects meta-analyses to summarize sensitivity and specificity of the 2 most commonly evaluated tests, Kalon gG2 enzyme-linked immunosorbent assay (ELISA), and Focus HerpeSelect HSV-2 ELISA. RESULTS: We identified 10 eligible articles that included 21 studies of the performance of Focus, and 12 of Kalon. The primary analyses included studies using the manufacturers' cut-offs (index value = 1.1). Focus had high sensitivity (random effects summary estimate 99%, 95% confidence interval [CI]: 99%-100%) but low specificity (69%, 95% CI: 59%-80%). Kalon had sensitivity of 95% (95% CI: 93%-97%) and specificity of 91% (95% CI: 86%-95%). Specificity of Focus was significantly lower (P = 0.002) among HIV-positive (54%, 95% CI: 40%-68%) than HIV-negative individuals (69%, 95% CI: 56%-82%). When the cut-off optical density index was increased above the recommended value of 1.1 to between 2.2 and 3.5, the specificity of Focus increased to 85% (95% CI: 77%-92%). CONCLUSIONS: Sensitivity and specificity of HSV-2 tests used in sub-Saharan Africa vary by setting, and are lower than reported from studies in the United States and Europe. Increasing the cut-off optical density index may improve test performance. Evaluation of test performance in a given setting may help deciding which test is most appropriate.


Asunto(s)
Anticuerpos Antivirales/sangre , Herpes Genital/diagnóstico , Herpesvirus Humano 2/inmunología , África del Sur del Sahara/epidemiología , Western Blotting , Ensayo de Inmunoadsorción Enzimática , Europa (Continente)/epidemiología , Herpes Genital/epidemiología , Herpes Genital/virología , Humanos , Técnicas para Inmunoenzimas , Juego de Reactivos para Diagnóstico , Sensibilidad y Especificidad , Pruebas Serológicas , Estados Unidos/epidemiología
9.
J Virol Methods ; 163(2): 276-81, 2010 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-19854222

RESUMEN

This study compared five serological tests with Western blot from University of Washington to determine the most accurate method for detecting antibodies to herpes simplex virus type 2 (HSV-2) in a male population in Kisumu, Kenya. A random sample of 250 fishermen from 18 beaches along Lake Victoria underwent serological testing by two generations of the HerpeSelect HSV-2 ELISA ("Focus Gen 1" and "Focus Gen 2"), Kalon HSV-2 ELISA ("Kalon"), Biokit HSV-2 Rapid Test ("Biokit"), and HerpeSelect Express Rapid HSV-2 ("Express") against the Western blot test ("WB") as the "gold standard". Sensitivity and specificity of tests in this population with a high prevalence of HSV-2 (58% by WB) were: Focus Gen 1: 98.6% and 63.5%; Focus Gen 2: 99.3% and 52.3%; Biokit: 66% and 90.9%; Express: 99.3% and 44.3% and Kalon: 98.6% and 85.7%. Increasing the positive cut-off value improved the specificity of the Focus Gen 2-84.9% and Kalon to 92.2%. Focus Gen 2 offered no improvement in specificity over that of Focus Gen 1. Neither rapid assay could be recommended as either a stand-alone assay or as a confirmatory test. The results of Kalon using a cut-off of 1.5 were the most concordant with those of WB for all the approaches tested. However, low positive Kalon test results should be interpreted with caution as they could reflect early seroconversion or false positive results.


Asunto(s)
Anticuerpos Antivirales/sangre , Herpes Genital/diagnóstico , Herpesvirus Humano 2/inmunología , Pruebas Serológicas/métodos , Adolescente , Adulto , Humanos , Kenia , Masculino , Sensibilidad y Especificidad , Adulto Joven
10.
Sex Transm Dis ; 36(10): 616-20, 2009 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-19617867

RESUMEN

OBJECTIVE: To investigate herpes simplex virus type-2 (HSV-2) seropositivity and associated risk factors in Vietnamese women. METHODS: Cross-sectional study with personal interviews and gynecological examinations among population-based samples of ever married women, aged 15 to 69 years, living in Ho Chi Minh City (HCMC) and Hanoi in 1997. Type-specific IgG antibodies against HSV-2 were detected using HerpeSelect ELISA (Focus Diagnostics). Adjusted prevalence ratios were estimated with log-binomial regression. RESULTS: HSV-2 seroprevalence was higher in 1106 women from HCMC (30.8%, 95% CI: 28.1-33.4, age-standardized to 2000 world standard population) than in 1170 women from Hanoi (8.8%, 95% CI: 7.1-10.5). In HCMC, HSV-2 seroprevalence was higher for women who were not married, HPV DNA positive, current hormonal contraceptive users, or had a history of multiple sexual partners or spontaneous abortion. HCMC seroprevalence was inversely associated with educational attainment, age at first intercourse, and age at first pregnancy. In the multivariable model for HCMC, a trend of increasing HSV-2 seroprevalence with age was observed, and prevalence ratios were nearly identical to age-adjusted prevalence ratios for marital status, age at first pregnancy, and HPV DNA positivity. CONCLUSIONS: HSV-2 was notably less prevalent in Hanoi than HCMC, where it was associated with traditional HSV-2 risk factors. These results are likely explained by socio-cultural, historical, economic, and demographic factors related to urban-rural and regional differences. Future population-based studies should include men and never-married women as a next step toward obtaining a more nearly complete picture of HSV-2 epidemiology in Vietnam.


Asunto(s)
Anticuerpos Antivirales/sangre , Herpes Genital/epidemiología , Herpesvirus Humano 2/inmunología , Adolescente , Adulto , Anciano , Estudios Transversales , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Inmunoglobulina G/sangre , Persona de Mediana Edad , Análisis de Regresión , Factores de Riesgo , Estudios Seroepidemiológicos , Parejas Sexuales , Vietnam/epidemiología
11.
Clin Vaccine Immunol ; 15(8): 1301-3, 2008 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-18508932

RESUMEN

Five hundred commercial sex workers in China were tested for herpes simplex virus type 2 by three immunoassays and Western blotting. Sensitivities for the Focus, Kalon, and Biokit assays were 86.7%, 82.3%, and 34.9%, respectively, and specificities were 91.8%, 94.2%, and 60.1%, respectively. The Focus assay performed optimally at an index of 1.5 (95.2% sensitivity and 93.4% specificity), and the Kalon assay performed optimally at an index of 1.2 (93.3% sensitivity and 95.2% specificity).


Asunto(s)
Anticuerpos Antivirales/sangre , Western Blotting/métodos , Herpes Genital/diagnóstico , Herpesvirus Humano 2/inmunología , Inmunoensayo/métodos , Juego de Reactivos para Diagnóstico , China , Femenino , Humanos , Curva ROC , Sensibilidad y Especificidad
12.
Clin Vaccine Immunol ; 15(5): 888-90, 2008 May.
Artículo en Inglés | MEDLINE | ID: mdl-18321879

RESUMEN

Ugandan subjects (820) were tested by Focus HerpeSelect enzyme-linked immunosorbent assay (ELISA), Kalon herpes simplex virus type 2 ELISA, and BioKit rapid test, and the results were compared to those of Western blotting. Higher-than-standard-index cutoff values gave optimal sensitivity and specificity. Kalon ELISA was the optimal assay when an index value of 1.5 was used (sensitivity, 91.7%; specificity, 92.4%).


Asunto(s)
Anticuerpos Antivirales/sangre , VIH/aislamiento & purificación , Herpes Genital/diagnóstico , Herpesvirus Humano 2/inmunología , Juego de Reactivos para Diagnóstico , Adolescente , Adulto , Ensayo de Inmunoadsorción Enzimática , Femenino , VIH/inmunología , Seropositividad para VIH/complicaciones , Herpes Genital/epidemiología , Humanos , Masculino , Sensibilidad y Especificidad , Uganda/epidemiología
13.
Clin Vaccine Immunol ; 15(2): 382-4, 2008 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-18077617

RESUMEN

Sera from 1,238 Vietnamese women in Hanoi were tested for herpes simplex virus type 2 (HSV-2). HSV-2 prevalence was 2.0%. The Kalon and Biokit assays showed significantly higher concordance to Western blotting data than did the Focus assay (P < 0.01). Screening by Focus and then retesting with Kalon/Biokit of positive samples can reduce falsely positive results significantly (P < 0.01).


Asunto(s)
Anticuerpos Antivirales/sangre , Herpes Simple/diagnóstico , Técnicas para Inmunoenzimas/métodos , Proteínas del Envoltorio Viral/inmunología , África Occidental , Reacciones Falso Positivas , Femenino , Herpes Simple/epidemiología , Herpes Simple/virología , Herpesvirus Humano 2/inmunología , Humanos , Juego de Reactivos para Diagnóstico , Sensibilidad y Especificidad , Estudios Seroepidemiológicos , Vietnam/epidemiología
14.
Clin Vaccine Immunol ; 14(12): 1545-9, 2007 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-17913866

RESUMEN

Two hundred seventy-nine serum samples from men attending sexually transmitted disease (STD) clinics in Baltimore, Maryland, were tested for herpes simplex virus type 2 (HSV-2)-specific antibody by three immunosorbent glycoprotein G-2-based assays (the Kalon, Focus, and Biokit assays). The results for all samples with positive results were confirmed by Western blotting (91/279; 32.6% HSV-2 seroprevalence). All patients were also tested for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, human immunodeficiency virus type 1, and hepatitis C virus. The Kalon assay performed very well with samples from this population (90.8% sensitive, 99.4% specific), whereas the Focus assay had a sensitivity (82.6%) much lower than that shown previously. For 19.7% of the samples, the Biokit assay gave an indeterminate result. It was found that the odds of a sample having a Biokit assay indeterminate result compared to that of having a definitive positive or negative results were 3.88 times greater for subjects concurrently infected with N. gonorrhoeae, after the effects of other STDs were controlled for (P = 0.001; 95% confidence interval, 1.78, 8.45). Unfortunately, we were unable to control for HSV-1 infection status in the regression model, which, on the basis of chi(2) analysis, might also affect the clarity of the Biokit test. The recommended index cutoff value of 1.1 for the Focus and Kalon assays was found to be optimal for this population.


Asunto(s)
Instituciones de Atención Ambulatoria , Anticuerpos Antivirales/análisis , Ensayo de Inmunoadsorción Enzimática , Herpesvirus Humano 2/inmunología , Juego de Reactivos para Diagnóstico , Adulto , Anticuerpos Antivirales/inmunología , Baltimore , Western Blotting , Distribución de Chi-Cuadrado , Humanos , Modelos Logísticos , Masculino , Valor Predictivo de las Pruebas , Análisis de Regresión , Sensibilidad y Especificidad , Enfermedades de Transmisión Sexual/complicaciones , Proteínas del Envoltorio Viral
15.
Pediatr Infect Dis J ; 25(10): 902-5, 2006 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-17006285

RESUMEN

BACKGROUND: Children and adolescents with a history of sexual abuse are at risk for acquiring herpes simplex virus (HSV) type 2. We evaluated the prevalence of HSV-1 and HSV-2 and the usefulness for this population of 2 commercially available tests. METHODS: Sera from 150 children seen in a sexual abuse clinic were analyzed for type-specific HSV antibodies using Focus HerpeSelect HSV-2 ELISA (Focus), Biokit HSV-2 Rapid Test (Biokit), and by Western blot (WB). RESULTS: The patient sample was 81% female, had a mean age of 11.6 years (range, 1 to 18 years), and was 46% Caucasian, 28% Hispanic, 25% African American, and 2% other. According to WB, 77 (51%) of the children were HSV-1 seropositive. For HSV-2, there was 1 "true positive" (positive by all 3 tests) and 1 patient whose serum had atypical HSV-2 bands by WB but was positive by Focus. There were 6 sera that were positive by Focus and negative by WB. Index values of these 6 Focus tests were not predictive of WB status. For the 105 samples for which Biokit data were available, all samples were concordant with WB. CONCLUSIONS: The findings of this study suggest that routine screening for HSV-2 in sexually abused children does not have a high yield. The Focus test has an unacceptably high rate of false-positive results in children; however, Biokit may be an acceptable substitute for WB in evaluating children for HSV-2 antibodies.


Asunto(s)
Abuso Sexual Infantil , Herpes Simple/epidemiología , Herpes Simple/virología , Herpesvirus Humano 1 , Herpesvirus Humano 2 , Adolescente , Anticuerpos Antivirales/sangre , Western Blotting , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática , Reacciones Falso Positivas , Femenino , Herpesvirus Humano 1/inmunología , Herpesvirus Humano 2/inmunología , Humanos , Lactante , Masculino , Prevalencia , Juego de Reactivos para Diagnóstico , Estudios Seroepidemiológicos
16.
Arch Pediatr Adolesc Med ; 160(9): 937-42, 2006 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-16953017

RESUMEN

OBJECTIVE: Human herpesvirus 8 (HHV-8) infection is common among children in areas where Kaposi sarcoma is endemic. Human herpesvirus 8 is uncommon in children but prevalent in adults at risk for human immunodeficiency virus (HIV) infection in the United States, including men who have sex with men (MSM) and women who engage in high-risk sexual behavior. We examined the prevalence and predictors of HHV-8 infection among adolescents with or at high risk for acquiring HIV infection. DESIGN: Cross-sectional analysis. SETTING: National study of HIV infection among adolescents in primary care. PARTICIPANTS: A total of 537 young adults practicing high-risk sexual behavior, of which 403 were women and 134 were men; among the 134 men, 75% were MSM. INTERVENTIONS: Detailed questionnaires and testing for serum antibodies to HHV-8. OUTCOME MEASURE: Detection of serum antibodies to HHV-8. RESULTS: Sixty (11.2%) of 537 young adults were HHV-8 seropositive, including 20 MSM (19.6%), 2 male heterosexuals (6.5%), and 27 female heterosexuals (8.2%). The prevalence of HHV-8 in HIV-positive MSM (17/74 [23.0%]) was twice as high as that in HIV-negative MSM (3/28 [10.7%]) (P = .18), but no characteristic predicted HHV-8 infection among MSM. In multivariate analysis, history of gonorrhea (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.4-5.7; P<.01), history of having sex with women (OR, 2.4; 95% CI, 1.1-5.3; P = .03), and African American race (OR, 3.4; 95% CI, 1.1-10.0; P = .03) were associated with HHV-8 infection among women. CONCLUSIONS: Human herpesvirus 8 is common among US adolescents practicing high-risk sexual behaviors. Sexual identity, race, and sexual behavior may influence the risk of infection with HHV-8 in women.


Asunto(s)
Infecciones por Herpesviridae/epidemiología , Herpesvirus Humano 8 , Adolescente , Estudios de Cohortes , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Humanos , Incidencia , Modelos Logísticos , Masculino , Prevalencia , Factores de Riesgo , Conducta Sexual , Encuestas y Cuestionarios , Estados Unidos/epidemiología
17.
J Infect Dis ; 194(1): 42-52, 2006 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-16741881

RESUMEN

BACKGROUND: Prospective studies of herpes simplex virus type 2 (HSV-2) infection in discordant couples have shown a low rate of transmission. However, unlike partners with genital herpes in prospectively monitored couples, most persons who transmit genital herpes are not aware of having the infection. METHODS: Because HSV has a short incubation period and most persons who acquire genital herpes can identify the transmitting partner, a time-to-event design was used to assess risks of HSV acquisition among patients with newly acquired genital herpes. RESULTS: Among 199 persons with laboratory-documented newly acquired genital herpes, the median duration of the sexual relationship with the transmitting partner was 3.5 months, and the median number of sex acts before transmission was 40. The median time to HSV-2 acquisition was greater among participants whose partners disclosed that they had genital herpes, compared with participants whose partners did not disclose their status (270 vs. 60 days; P = .03). In multivariate models, having a partner who disclosed that he or she had genital herpes remained a strong protective factor against genital HSV-2 acquisition (hazard ratio, 0.48 [95% confidence interval, 0.25-0.91]). CONCLUSION: These findings suggest that testing persons with HSV type-specific serologic assays and encouraging disclosure may result in a decreased risk of HSV-2 transmission to sex partners.


Asunto(s)
Herpes Genital/prevención & control , Herpes Genital/transmisión , Herpesvirus Humano 2/patogenicidad , Conducta Sexual , Parejas Sexuales , Adolescente , Adulto , Revelación/normas , Femenino , Herpesvirus Humano 1/patogenicidad , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Factores de Riesgo , Factores de Tiempo
18.
AIDS ; 20(7): 1051-8, 2006 Apr 24.
Artículo en Inglés | MEDLINE | ID: mdl-16603858

RESUMEN

OBJECTIVE: To determine the prevalence of infection with herpes simplex virus types 1 (HSV-1) and 2 (HSV-2) among women with and at high risk for HIV infection, and to evaluate the effect of HAART on the recurrence of genital lesions. METHODS: We evaluated the epidemiology and clinical manifestations associated with HSV-1 and HSV-2 among 1796 HIV-infected and 476 HIV-uninfected women enrolled in a multisite cohort study. Serum antibodies to HSV-1 and HSV-2 at baseline and self-reported history of genital herpes, reports of recent genital sores and presence of genital ulcers on examination, and use of HAART regimen at each study visit were analyzed. RESULTS: Reactivity to HSV-1 only and HSV-2 only was detected in 18% and 20% of HIV-infected, and in 28% and 18% of HIV-uninfected participants respectively; 58% of HIV-infected women and 45% of HIV-uninfected women were seropositive for both HSV types. Reactivity to HSV-2 was associated with increasing age, more male sexual partners, earlier sexual debut, African-American race, Latina ethnicity, less education and lower income. HIV-uninfected women reported significantly fewer genital sores than HIV-infected women who had used HAART for at least 1 year and had optimal CD4 cell gain and viral suppression (adjusted odds ratio (OR), 0.19; 95% confidence interval (CI), 0.13-0.28). CONCLUSION: Use of HAART and subsequent immune recovery does not completely eliminate the effect of HIV infection on genital lesions among women with concurrent HSV-2 infection.


Asunto(s)
Terapia Antirretroviral Altamente Activa/métodos , Infecciones por VIH/epidemiología , VIH-1/inmunología , Herpes Genital/epidemiología , Adolescente , Adulto , Anticuerpos Antivirales/análisis , Recuento de Linfocito CD4 , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/etnología , Herpes Genital/etnología , Herpes Genital/inmunología , Herpesvirus Humano 1/inmunología , Herpesvirus Humano 2/inmunología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Conducta Sexual , Parejas Sexuales , Factores Socioeconómicos , Úlcera/epidemiología , Úlcera/etnología , Úlcera/inmunología , Estados Unidos/epidemiología
19.
Sex Transm Dis ; 33(7): 441-4, 2006 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-16540882

RESUMEN

OBJECTIVES: We conducted this study to examine the incidence, prevalence, and risk factors for herpes simplex virus (HSV) 1 and HSV 2 infection in a cohort of young women who were closely followed for acquisition of sexually transmitted infections. STUDY DESIGN: Women between the ages of 14 and 18 years had blood and genital specimens obtained quarterly to test for incident sexually transmitted infections. Subjects also had 2 12-week periods each year when they kept a detailed behavioral diary and performed weekly vaginal swabs. Serum specimens were tested for HSV 1 and HSV 2 antibody, and genital specimens were tested for HSV DNA by PCR. RESULTS: A total of 100 subjects enrolled and had at least 2 sera that could be analyzed for seroconversion. The mean age of the subjects was 15.8 years at entry. The HSV 1 and HSV 2 seroprevalence at entry was 59.6% and 13.5%, respectively. During the study, 4 subjects acquired HSV 1 antibody and 7 acquired HSV 2 antibody, but there were no cases of symptomatic HSV infection identified. The annualized incidence among susceptible individuals was 8.9% for HSV 1 and 7.4% for HSV 2. Three of the 7 HSV 2 sero-converters had HSV 2 DNA detected in vaginal swabs. Age, duration of sexual activity, and the presence of other sexually transmitted infections were predictors of HSV 2 antibody positivity. CONCLUSIONS: Acquisition of HSV 1 and HSV 2 is relatively common in adolescent women, although symptomatic infection is uncommon. HSV 2 is shed in the genital tract despite the lack of symptoms.


Asunto(s)
Herpes Genital/epidemiología , Herpes Genital/prevención & control , Herpesvirus Humano 1/inmunología , Herpesvirus Humano 2/inmunología , Adolescente , Servicios de Salud del Adolescente , Anticuerpos Antivirales/sangre , Estudios de Cohortes , ADN Viral/análisis , Femenino , Herpes Genital/etiología , Herpesvirus Humano 1/genética , Herpesvirus Humano 2/genética , Humanos , Incidencia , Reacción en Cadena de la Polimerasa , Prevalencia , Factores de Riesgo , Washingtón/epidemiología
20.
Am J Obstet Gynecol ; 193(6): 1891-9, 2005 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-16325589

RESUMEN

OBJECTIVE: This study was undertaken to determine risk factors for herpes simplex virus (HSV) acquisition among at risk pregnant women. STUDY DESIGN: Women in a prospective study of HSV acquisition in pregnancy invited their sexual partners for HSV type-specific serologic testing. Risk factors for HSV susceptibility, exposure, and acquisition were examined. RESULTS: A total of 3192 couples enrolled; 22% included women at risk for HSV-1 or HSV-2. Among 582 HSV-1 seronegative women with HSV-1 seropositive partners, 14 (3.5% adjusted for gestation length) acquired HSV-1. Having a partner with a history of oral herpes was associated with HSV-1 acquisition (odds ratio [OR] 8.1, 95% CI: 1.8-36.0) and accounted for 75% of incident infections. Among 125 HSV-2 seronegative women with HSV-2 seropositive partners, 17 (20% adjusted for gestation length) acquired HSV-2. Duration of partnership of 1 year or less was associated with HSV-2 acquisition (OR 7.8, 95% CI: 2.3-25.7) and accounted for 63% of incident infections. No combination of clinical characteristics could identify the majority of susceptible women with serologically discordant partners. CONCLUSION: HSV acquisition rates in pregnancy are high in discordant couples, especially for HSV-2. Interventions that address risk factors for HSV acquisition should be studied in pregnancy. Clinical profiles cannot replace serologic screening to identify susceptible women with serologically discordant partners.


Asunto(s)
Herpes Simple/epidemiología , Herpesvirus Humano 1 , Herpesvirus Humano 2 , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/epidemiología , Parejas Sexuales , Adulto , Anticuerpos Antivirales , Western Blotting , Femenino , Herpes Genital/epidemiología , Herpes Genital/transmisión , Herpes Simple/transmisión , Humanos , Modelos Logísticos , Oportunidad Relativa , Embarazo , Estudios Prospectivos , Factores de Riesgo , Washingtón/epidemiología
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