HSV-2 serology can be predictive of HIV epidemic potential and hidden sexual risk behavior in the Middle East and North Africa

Abstract

Background HIV prevalence is low in the Middle East and North Africa (MENA) region, though the risk or potential for further spread in the future is not well understood. Behavioral surveys are limited in this region and when available have serious limitations in assessing the risk of HIV acquisition. We demonstrate the potential use of herpes simplex virus-2 (HSV-2) seroprevalence as a marker for HIV risk within MENA. Methods We designed a mathematical model to assess whether HSV-2 prevalence can be predictive of future HIV spread. We also conducted a systematic literature review of HSV-2 seroprevalence studies within MENA. Results We found that HSV-2 prevalence data are rather limited in this region. Prevalence is typically low among the general population but high in established core groups prone to sexually transmitted infections such as men who have sex with men and female sex workers. Our model predicts that if HSV-2 prevalence is low and stable, then the risk of future HIV epidemics is low. However, expanding or high HSV-2 prevalence (greater than about 20%), implies a risk for a considerable HIV epidemic. Based on available HSV-2 prevalence data, it is not likely that the general population in MENA is experiencing or will experience such a considerable HIV epidemic. Nevertheless, the risk for concentrated HIV epidemics among several high-risk core groups is high. Conclusions HSV-2 prevalence surveys provide a useful mechanism for identifying and corroborating populations at risk for HIV within MENA. HSV-2 serology offers an effective tool for probing hidden risk behaviors in a region where quality behavioral data are limited.

Mathematical models for the study of HIV spread and control amongst men who have sex with men

“…The analysis relied heavily on the published model descriptions. Lack of information in any of the areas covered in this review may High-efficacy preventive vaccines that target high-risk groups 2010 [65] Use HSV-2 prevalence surveys to help monitor the extent of HIV infection 2010 [44] Transmission elimination…”

“…In Latin America, predictions were made with models that explicitly link the HIV transmission amongst homosexuals, bisexuals, and heterosexual males and females (Argentina [7], Cuba [41], and Mexico [42]); while the trajectory of HIV MSM epidemics in Asian (China [43]) and African countries [44] were investigated only recently.…”

A model for the coupled disease dynamics of HIV and HSV-2 with mixing among and between genders

“…Moreover, between 40 and 80% of individuals diagnosed * Corresponding author. with HIV are co-infected with HSV-2, with a large portion of these individuals from among the homosexual male population [5][6][7].…”

“…Many mathematical models discuss HIV or HSV-2 alone [8][9][10][11][12], and a few discuss the relationship between HIV and HSV-2 [5,6,13,14]. For instance, Blower and Ma [6] coupled an HIV compartmental model with an HSV-2 model to investigate the effects of HSV-2 prevalence on the number of new cases of HIV; Abu-Raddad et al [5] consider a homosexual male population and suggest that HSV-2 prevalence, if near an endemic level, may predict the spread of HIV; and Foss et al [13] developed a dynamic model to estimate the HIV infections directly due to HSV-2 in a heterosexual population.…”

“…This is mainly due to the lesions that are caused by HSV-2 infection and facilitate infection by other STDs, making infected individuals 2-5 times more likely to contract HIV [1][2][3][4]. Co-infection also allows for an enhanced transmission of HIV as co-infected individuals have a higher concentration of HIV in their genital fluids than individuals with HIV only [1,3,4]. Moreover, between 40 and 80% of individuals diagnosed * Corresponding author.…”