Sexually Transmitted Diseases  >  Publications  >  Report of the Genital Herpes Prevention Consultants Meeting May 5-6, 1998

Report of the Genital Herpes Prevention Consultants Meeting May 5-6, 1998

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5. Interactions Between Genital Herpes and HIV Infection

The evidence for a substantial contribution of genital herpes to HIV transmission in the United States was reviewed, as were data suggesting that HSV infection may adversely affect the progression of immunodeficiency in HIV-infected persons. Studies also show that among persons with HSV-2 infection, the frequency of subclinical shedding of HSV-2 is higher in HIV-infected than in HIV-uninfected persons. It is unknown whether antiherpetic chemotherapy might reduce the potential for HIV transmission in dually infected persons. Similarly, it is unknown whether highly active anti-retroviral therapy (HAART) might influence HSV shedding. These observations suggest a possible future role for antiviral chemotherapy in preventing HIV transmission, HSV transmission, or clinical management of persons infected with both HSV and HIV.

CDC should recommend that all HIV-infected persons be evaluated for genital herpes, including type-specific serological testing. There were strongly asserted opinions both for and against this recommendation, without consensus; it was viewed as high priority by those in favor. The experts recommending against this advice prefer to await the results of the following research agenda.

Research should address the efficacy of antiherpetic chemotherapy in reducing HIV transmission and the effect of such treatment on HIV viral load and progression of immunodeficiency (consensus high, priority high).

CDC should conduct or support operational and behavioral research on appropriate counseling and testing messages and strategies for HSV/HIV coinfection (e.g., reinforcement of the need for compliance with the antiherpetic regimen, avoidance of sex during symptomatic recurrences, use of condoms) (consensus high, priority high).

The effect of highly active antiretroviral therapy (HAART) on clinical manifestations of genital herpes and subclinical shedding of HSV in dually infected persons should be studied (consensus high, priority high).

The legal and ethical implications of serial HSV-2 testing in HIV infected persons deserve special attention in designing demonstration projects and/or formulating recommendations for clinical management (consensus and priority not stated).

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