Decline in Herpes Simplex Virus Type 2 Among Non-Injecting Heroin and Cocaine Users in New York City, 2005 to 2014: Prospects for Avoiding a Resurgence of Human Immunodeficiency Virus

Abstract

Background Herpes simplex virus type II (HSV-2) infection increases both susceptibility to and transmissibility of HIV, and HSV-2 and HIV are often strongly associated in HIV epidemics. We assessed trends in HSV-2 prevalence among non-injecting drug users (NIDUs) when HIV prevalence declined from 16% to 8% among NIDUs in New York City. Methods Subjects were current non-injecting users of heroin and/or cocaine and who had never injected illicit drugs. 3157 NIDU subjects were recruited between 2005–2014 among persons entering Mount Sinai Beth Israel substance use treatment programs. Structured interviews, HIV and HSV-2 testing were administered. Change over time was assessed by comparing 2005–2010 to 2011–2014 time periods. HSV-2 incidence was estimated among persons who participated in multiple years. Results HSV-2 prevalence was strongly associated with HIV prevalence (OR=3.9, 95% CI 2.9–5.1) from 2005–2014. HSV-2 prevalence declined from 60% to 56% (p=0.01). The percentage of NIDUs with neither HSV-2 nor HIV infection increased from 37% to 43%, (p<0.001); the percentage with HSV-2/HIV co-infection declined from 13% to 6%, (p<0.001). Estimated HSV-2 incidence was 1 – 2/100 person-years at risk Conclusions There were parallel declines in HIV and HSV-2 among NIDUs in New York City from 2005 to 2014. The increase in the percentage of NIDUs with neither HSV-2 nor HIV infection, the decrease in the percentage with HSV-2/HIV co-infection, and the low to moderate HSV-2 incidence suggest some population-level protection against resurgence of HIV. Prevention efforts should be strengthened to end the combined HIV/HSV-2 epidemic among NIDUs in the city.

Geographic distribution of risk (“Hotspots”) for HIV, HCV, and drug overdose among persons who use drugs in New York City: the importance of local history

“…To assess potential hotspots for sexual transmission of HIV, we included data from both PWID and non-injecting drug users (together termed people who use drugs, PWUD). As noted above, New York City experienced a substantial sexual transmission HIV epidemic among both PWID and non-injecting drug users [27, 28]. The risk for sexual transmission of HIV was facilitated by the high rates of HSV-2 infection, which facilitates both transmission and acquisition of HIV [29].…”

High prevalence of sexually transmitted infections and risk factors among HIV-positive individuals in Yunnan, China

“…HSV-2 was the most common STI that was detected, with an overall prevalence of 33.2% (135/406) in HIV-positive individuals in this study. The prevalence of HSV-2/HIV coinfection was much higher than the 6%-13% observed in noninjecting drug users [ 25 ], but it was less than that of 48.6% in HIV-positive MSM in Shenyang [ 26 ]. Active syphilis was also a familiar STI that was observed, with a prevalence of 11.8% (24/204) in the ART-naive group and 11.4% (23/202) in the ART group.…”