Frequent Genital HSV-2 Shedding among Women during Labor in Soweto, South Africa

Table 2

(a) Risk factors for HSV-2 infection and genital HSV-2 shedding in labor among HSV-2 seropositive women. (b) Risk factors for HSV-2 infection and genital HSV-2 shedding in labor among HSV-2 seropositive women coinfected with HIV.

(a)

Variable	Genital HSV-2 shedding among HSV-2 seropositive women^a,b				HSV-2 seropositivity
	Genital HSV-2 present, 𝑛=39; 𝑛 (%)	Genital HSV-2 not present, 𝑛=188; 𝑛 (%)	Unadjusted RR (95% CI)^c,d	𝑃 value	HSV-2 seropositive, 𝑛=229; 𝑛 (%)	HSV-2 seronegative, 𝑛=161; 𝑛 (%)	Unadjusted RR (95% CI)^c	𝑃 value	Adjusted RR (95% CI)^c,e	𝑃 value
HIV status
HIV-positive	26 (22.6)	89 (77.4)	1.91 (1.04, 3.53)	0.038	116 (87.9)	16 (12.1)	2.02 (1.73, 2.35)	<0.001	1.69 (1.45, 1.96)	<0.001
HIV-negative	13 (11.8)	97 (88.2)	1.00 (ref.)		111 (43.5)	144 (56.5)	1.00 (ref.)		1.00 (ref.)
Age, per each 10 y increase			0.68; (0.41, 1.13)	0.14			1.62 (1.45, 1.82)	<0.001	1.28 (1.12, 1.46)	<0.001
Gravidity
Primigravid	10 (24)	32 (76)	1.0 (ref.)		42 (31.1)	93 (68.9)	1.00 (ref.)		1.00 (ref.)
Multigravid	28 (15.5)	153 (84.5)	0.65 (0.34, 1.23)	0.19	183 (74.4)	63 (25.6)	2.39 (1.84, 3.11)	<0.001	1.68 (1.26, 2.25)	<0.001

Abbreviations: RR: relative risk; HAART: highly active antiretroviral therapy (≥ three antiretroviral drugs). Missing data: genital HSV DNA (𝑛=2), HIV-status (𝑛=3), gravidity (𝑛=9), and CD4 count (𝑛=6). Percentages determined by excluding those with missing data from the denominator. ^aHSV DNA was typed as HSV-2 in all cases. ^bGenital HSV-2 DNA was not detected in any HSV-2 seronegative women. ^cAs determined by Poisson regression. ^dOnly HIV-status remained significantly associated with HSV-2 shedding after inclusion of maternal age and history of prior pregnancy in a multivariate model and backwards elimination of nonsignificant (𝑃<0.05) variables. ^eAdjusted for HIV-status, age, and prior pregnancy.

(b)

Variable	Genital HSV-2 shedding among HSV-2 seropositive women^a,b				HSV-2 seropositivity
	Genital HSV-2 present, 𝑛=26; 𝑛 (%)	Genital HSV-2 not present, 𝑛=89; 𝑛 (%)	Unadjusted RR (95% CI)^c	𝑃 value	HSV-2 seropositive, 𝑛=116; 𝑛 (%)	HSV-2 seronegative, 𝑛=16; 𝑛 (%)	Unadjusted RR (95% CI)^c	𝑃 value
CD4 count, cells/μL
<200	7 (28)	18 (72)	1.3 (0.5, 3.5)	0.62	25 (96)	1 (4)	1.1 (0.9, 1.3)	0.18
200–349	7 (20)	28 (80)	0.9 (0.3, 2.6)	0.87	36 (84)	7 (16)	1.0 (0.8, 1.2)	0.87
350–499	6 (23)	20 (77)	1.1 (0.4, 3.0)	0.91	26 (87)	4 (13)	1.0 (0.8, 1.3)	0.87
≥500	5 (22)	18 (78)	1.0 (ref.)		23 (85)	4 (15)	1.0 (ref.)
Receiving HAART
Yes	12 (26)	34 (74)	1.3 (0.7, 2.5)	0.47	47 (90)	5 (10)	1.0 (0.9, 1.2)	0.46
No	14 (20)	55 (80)	1.0 (ref.)		69 (86)	11 (14)	1.0 (ref.)
HAART regimen containing tenofovir
Yes	4 (22)	14 (78)	0.8 (0.3, 2.2)	0.64	19 (86)	3 (14)	0.9 (0.8, 1.1)	0.43
No	8 (29)	20 (71)	1.0 (ref.)		28 (93)	2 (7)	1.0 (ref.)

Abbreviations: RR: relative risk; HAART: highly active antiretroviral therapy (≥ three antiretroviral drugs). Missing data: genital HSV DNA (𝑛=1), gravidity (𝑛=1), and CD4 count (𝑛=6). Percentages determined by excluding those with missing data from the denominator. ^aHSV DNA was typed as HSV-2 in all cases. ^bGenital HSV-2 DNA was not detected in any HSV-2 seronegative women. ^cAs determined by Poisson regression.