Frequent Recovery of HIV-1 From Genital Herpes Simplex Virus Lesions in HIV-1–Infected Men

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Abstract
SEVERAL epidemiologic studies have shown an association between the acquisition of the human immunodeficiency virus 1 (HIV-1) and the reported presence of genital lesions in the presumed source contact.1-6 In 1 study of discordant couples with HIV-1 infection, presence of a genital ulcer in the source partner was associated with a 5-fold greater risk in the transmission of HIV-1.7 Worldwide, the most common infectious etiologies of genital ulcers are herpes simplex virus (HSV), syphilis, and chancroid,8,9 with HSV the most common in North America and Europe, accounting for 75% to 80% of infectious genital ulcers.10 One of the first reports of a common source cluster of sexually transmitted HIV-1 infection in Europe emanated from an HIV-1–infected individual who on retrospective questioning was noted to have genital HSV-2 infection.4 Recent studies have shown that genital herpes is the most frequent sexually transmitted disease among HIV-1–seropositive persons,11 and most HSV-2–seropositive persons (whether HIV-1 infected or immunocompetent) intermittently reactivate the virus on mucosal surfaces.12-14 Clinically, HSV-2 causes lesions that are smaller and of shorter duration than those caused by chancroid or syphilis, and HSV-2 ulcerations often occur in locations difficult to visualize, such as the cervix or perineal region.13,15 As such, the true prevalence of clinically described genital lesions due to HSV among persons suspected of transmitting HIV-1 is likely to be underestimated. We undertook a study to evaluate the frequency, titer, and duration of HIV-1 in genital HSV-2 lesions; to relate lesional titers of HIV-1 RNA to plasma titers of HIV-1 RNA; to examine the association between lesional HIV-1 RNA with HSV-2 in culture; and to compare HIV-1 quasi species in lesions and plasma. As the HIV-1 epidemic in Seattle, Wash, is largely present in the homosexual/bisexual male population, our study enrolled gay men.