PMID- 28600331 OWN - NLM STAT- MEDLINE DCOM- 20180313 LR - 20181202 IS - 1472-3263 (Electronic) IS - 1368-4973 (Print) IS - 1368-4973 (Linking) VI - 93 IP - 8 DP - 2017 Dec TI - Does maternal HSV-2 coinfection increase mother-to-child transmission of HIV? A systematic review. PG - 535-542 LID - 10.1136/sextrans-2016-052921 [doi] AB - BACKGROUND: Reducing HIV mother-to-child transmission (MTCT) is critical to ending the HIV pandemic. Reports suggest that herpes simplex virus-2 (HSV-2), a common coinfection in HIV-infected individuals, is associated with increased MTCT, but results have been conflicting. We conducted a systematic review of observational studies to quantify the magnitude of this relationship (PROSPERO no. CRD42016043315). METHODS: We searched Medline (1981 to June week 3, 2016), EMBASE (1981 to week 26, 2016), relevant conferences (2013-2016) and bibliographies of identified studies for cohort and case-control studies enrolling HIV-positive women during pregnancy or peripartum that quantified the effect of HSV-2 infection on MTCT. The primary outcome was the risk of perinatal HIV transmission associated with maternal HSV-2 status. Risk of bias was evaluated using a standardised tool, and results were meta-analysed where appropriate using a random-effects model, with studies weighted using the inverse variance method. RESULTS: From 2103 hits, 112 studies were considered for inclusion, and 10 were ultimately included. Of the included studies, three used a case-control design, three were retrospective cohorts and four were prospective cohorts. Risk of bias was low in three studies, moderate in six and high in one. The median sample size was 278.5 mother-infant pairs (range: 48-1513). The most common strategy for classifying maternal HSV-2 status was type-specific serology (n=6), followed by genital shedding (n=3) or genital culture (n=3), clinical diagnosis of herpes (n=2) or genital ulcer disease (n=1). Results from five studies that provided quantitative estimates of the association between HSV-2 seropositivity and MTCT were meta-analysed, yielding a pooled unadjusted OR=1.17 (95% CI=0.69 to 1.96, I(2)=58%). Three of these studies further considered key confounding variables, specifically antiretroviral use and/or viral load (n=3), and mode of delivery (n=2), yielding a pooled adjusted OR=1.57 (95% CI=1.17 to 2.11, I(2)=0). CONCLUSIONS: Maternal HSV-2 coinfection appears to be associated with increased perinatal HIV transmission. Further study of the effect of HSV-2 treatment on MTCT is warranted. CI - (c) Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. FAU - Sivarajah, Vishalini AU - Sivarajah V AD - Faculty of Medicine, University of Toronto, Toronto, Canada. FAU - Venus, Kevin AU - Venus K AD - Faculty of Medicine, University of Toronto, Toronto, Canada. FAU - Yudin, Mark H AU - Yudin MH AD - Department of Obstetrics and Gynaecology, St. Michael's Hospital, Toronto, Canada. AD - Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada. FAU - Murphy, Kellie E AU - Murphy KE AD - Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada. AD - Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Canada. FAU - Morrison, Steven A AU - Morrison SA AD - Faculty of Medicine, University of Toronto, Toronto, Canada. FAU - Tan, Darrell Hs AU - Tan DH AD - Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada. AD - Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada. AD - Department of Medicine, University of Toronto, Toronto, Ontario, Canada. LA - eng GR - CIHR/Canada PT - Journal Article PT - Review PT - Systematic Review DEP - 20170609 PL - England TA - Sex Transm Infect JT - Sexually transmitted infections JID - 9805554 RN - 0 (Antibodies, Viral) SB - IM MH - Antibodies, Viral/blood MH - Coinfection/*epidemiology/virology MH - Female MH - HIV Infections/*epidemiology/*transmission/virology MH - Herpes Genitalis/*epidemiology/virology MH - *Herpesvirus 2, Human/isolation & purification MH - Humans MH - Infectious Disease Transmission, Vertical/prevention & control/*statistics & numerical data MH - Observational Studies as Topic MH - Pregnancy MH - Pregnancy Complications, Infectious/*epidemiology/virology MH - Prevalence MH - Risk Factors MH - Seroepidemiologic Studies MH - Viral Load PMC - PMC5739864 OTO - NOTNLM OT - HIV OT - coinfection OT - herpesvirus-2 OT - human OT - infant OT - mother OT - transmission COIS- Competing interests: DHST has received honouraria from Abbvie, Gilead, Merck and Viiv Healthcare, has been awarded grants for investigator-initiated studies from Gilead and Viiv Healthcare and is a site principal investigator for clinical trials sponsored by GSK. EDAT- 2017/06/11 06:00 MHDA- 2018/03/14 06:00 PMCR- 2017/12/21 CRDT- 2017/06/11 06:00 PHST- 2016/10/07 00:00 [received] PHST- 2017/05/01 00:00 [revised] PHST- 2017/05/06 00:00 [accepted] PHST- 2017/06/11 06:00 [pubmed] PHST- 2018/03/14 06:00 [medline] PHST- 2017/06/11 06:00 [entrez] PHST- 2017/12/21 00:00 [pmc-release] AID - sextrans-2016-052921 [pii] AID - 10.1136/sextrans-2016-052921 [doi] PST - ppublish SO - Sex Transm Infect. 2017 Dec;93(8):535-542. doi: 10.1136/sextrans-2016-052921. Epub 2017 Jun 9.