Genital herpes may raise HIV transmissibility. (Accelerates Disease Course).

SAN FRANCISCO -- Physicians have long shrugged off genital herpes as basically a trivial infection, when in fact there is persuasive evidence that herpes simplex virus type 2 is a major force driving the AIDS epidemic, Dr. Lawrence Corey said at the annual meeting of the Infectious Diseases Society of America.

Not only do persons infected with herpes simplex virus type 2 (HSV-2) have up to a fivefold increased risk of acquiring HIV, it's now clear that coinfection with HIV-1 and HSV-2 increases HIV transmissibility and accelerates the course of HIV disease, Dr. Corey said in the annual John F. Enders Distinguished Lecture in Medical Virology. Further, coinfection leads to a marked upregulation of HIV replication peripherally, and HSV-2 shedding facilitates HIV shedding on mucosal surfaces.

The two viruses are "the odd couple" in terms of their dissimilar particle size, genome size, latency and replication sites, and adaptation to humans. But they interact synergistically: HSV-2 boosts HIV's infectivity, while HIV alters the natural history of HSV-2, resulting in more frequent HSV reactivation than in HIV-negative individuals, explained Dr. Corey, professor of medicine and of laboratory medicine at the University of Washington, Seattle, and head of the infectious diseases division at the Fred Hutchison Cancer Research Center in Seattle.

New data from the landmark HIV epidemiologic study in the Rakai district of rural Uganda demonstrate that an HIV-negative and HSV-2-seropositive individual whose sexual partner is HIV infected has a fivefold greater risk per sexual contact of acquiring HIV, compared with an HSV-2-seronegative partner.

The HSV-2-positive partner of an HIV-infected individual in the Rakai having a low viral load had an HIV acquisition rate as high as that of an ...