Herpes Simplex Virus Type 2, Genital Ulcers and HIV-1 Disease Progression in Postpartum Women 英文参考文献.docVIP

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Herpes Simplex Virus Type 2, Genital Ulcers and HIV-1 Disease Progression in Postpartum Women 英文参考文献.doc

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Herpes Simplex Virus Type 2, Genital Ulcers and HIV-1 Disease Progression in Postpartum Women 英文参考文献

HerpesSimplexVirusType2,GenitalUlcersandHIV-1 DiseaseProgressioninPostpartumWomen AlisonC.Roxby1*,AlisonL.Drake2,GraceJohn-Stewart1,2,3,ElizabethR.Brown4,DanielMatemo5, PhelgonaA.Otieno6,CareyFarquhar1,2,3 1DepartmentofMedicine,UniversityofWashington,Seattle,Washington,UnitedStatesofAmerica,2DepartmentofGlobalHealth,UniversityofWashington,Seattle, Washington, United States of America, 3Department of Epidemiology, University of Washington, Seattle, Washington, United States of America, 4Department of Biostatistics,UniversityofWashington,Seattle,Washington,UnitedStatesofAmerica,5DepartmentofObstetricsandGynaecology,UniversityofNairobi,Nairobi,Kenya, 6CentreforClinicalResearch,KenyaMedicalResearchInstitute,Nairobi,Kenya Abstract Background:Co-infectionwithherpessimplexvirustype2(HSV-2)hasbeenassociatedwithincreasedHIV-1RNAlevelsand immuneactivation,twopredictorsofHIV-1progression.TheimpactofHSV-2onclinicaloutcomesamongHIV-1infected pregnantwomenisunclear. Methods: HIV-1 infected pregnant women in Nairobi were enrolled antenatally and HSV-2 serology was obtained. HIV-1 RNA and CD4 count were serially measured for 12–24 months postpartum. Survival analysis using endpoints of death, opportunisticinfection(OI),andCD4,200cellsmL,andlinearmixedmodelsestimatingrateofchangeofHIV-1RNAand CD4,wereusedtodetermineassociationsbetweenHSV-2serostatusandHIV-1progression. Results:Among296women,254(86%)wereHSV-2-seropositive.Only30(10%)womenhadpriororcurrentgenitalulcer disease(GUD);medianbaselineCD4countwas422cellsmL.AdjustingforbaselineCD4,womenwithGUDweresignificantly morelikelytohaveincidentOIs(adjustedhazardratio(aHR)2.79,95%CI:1.33–5.85),andtherewasatrendforassociation betweenHSV-2-seropositivityandincidentOIs(aHR3.83,95%CI:0.93–15.83).RateofchangeinCD4countandHIV-1RNA didnotdifferbyHSV-2statusorGUD,despiteatrendtowardhigherbaselineHIV-1RNAinHSV-2-seropositivewomen(4.73 log10copies/mlvs.4.47log10copies/ml,P=0.07). Conclusions:HSV-2washighlyprevalentandpregnantHIV-1infectedwomenw