American HIV-positive women have high prevalence of other chronic viral infections

American HIV-positive women, and those at high risk of HIV, are also likely to be infected with other chronic viral infections which can cause long-term health problems, according to research published in the May 1^st 2003 edition of the Journal of Infectious Diseases.

Historically, HIV has mainly affected gay men in the US and the prevalence and risk factors for other viral infections amongst gay men has been, and still is the subject of research. However, in recent years, increasing number of women, mainly from ethnic minorities and often poor and badly educated have tested HIV-positive. Investigators involved in the US HIV Epidemiology Research Study (HERS) set out to provide “robust” estimates of the prevalence of seven chronic viral infections in 871 HIV infected women and 439 HIV-negative women who were at high risk of HIV. Women were recruited from four large US cities and were required to attend six-monthly appointments, when they were asked to complete a questionnaire, have blood and urine samples taken and undergo a physical examination. The study lasted from 1993 to 1999.

Investigators tested women for the presence of viral infections with the potential to cause chronic health problems in their own right, even if HIV is not present, or to facilitate the onward transmission of HIV. The infections were hepatitis B (HBV); hepatitis C (HCV); cytomegalovirus (CMV); human herpes virus 8 (HHV-8), the cause of Kaposi's sarcoma; human papillomavirus (HPV), which can cause cervical cancer, and herpes simples virus 1 and 2 (HSV 1 and HSV 2).

Information was also gathered to assess the women’s risk factors for these infections. These included age, race, educational attainment, income, number of sexual history, history of selling sex, age at first sexual contact, smoking crack cocaine and other drug use, and cigarette smoking.

Study finds over 50% prevalence of infections

Two-thirds of the women in the study had HIV, and the majority of the women were black, and on a low income. Nearly two-thirds had a history of smoking crack cocaine, 40% reported selling sex, and 28% said that they had had over 20 sexual partners. Over 50% failed to complete high school and the overwhelming majority, 87%, were cigarette smokers.

Having HIV was significantly associated with having all the viral infections in the study, except for HSV 1. In addition, having HIV was found to be strongly associated with having four or more of the chronic viral infections in the study. The risk of having CMV was found to be strongly associated with being black. HBV and HCV were strongly associated with injecting drug use. Even when risk factors such as sexual history, and drug use were controlled for, low education was a risk factor for CMV, HBV, HCV, HSV-1 and HSV-2, and low income a predictor for HCV and HSV-1. Having HIV was a risk factor for multiple infections, irrespective of demographic variables.

Over 50% of women had CMV, HBV, HCV, HPV and HSV-1 and HSV-2. The investigators note, “overall the prevalence of viral infections among these women ranged from 2 to 30 times as high as previously reported prevalences among women from the general population.” The investigators believe that the prevalence of infections found amongst women in their study is representative of HIV-positive women in the US, given their study’s recruitment.

The potential health implications for HIV-positive women of infection with CMV, HHV-8, HPV and HBV and HCV are emphasised by the investigators. The high prevalence of infections also has potential implications for HIV prevention efforts. As HIV was strongly associated with multiple infections even when risk behaviour was controlled for, the investigators suggest that “HIV may facilitate the transmission of other viruses, and other viruses may facilitate the transmission of HIV.”

Evidence of sexual transmission of HCV

Possible evidence for the sexual transmission of HCV was also found by the investigators, as 10.5% of women coinfected with HCV only had sex as a risk factor for the infection. This “might be explained by the higher number of sex partners” women in this study had, and “a higher prevalence of HCV infection in sex partners”. Click here to read recent evidence for sexual transmission of HCV amongst gay men and heterosexuals.

Behvioural and social factors both have role

However, behaviour was not the only predictor of having viral coinfections. The investigators note that, “socioeconomic factors, such as lower levels of education and income, were associated with all 7 viral infections” and “several viral infections were independently associated with low socioeconomic level” even when other risk factors were controlled for.

Further information on this website

Hepatitis B - overview

Hepatitis C - overview

HIV and hepatitis - Booklet in the information for HIV-positive people series (pdf)

CMV - overview

Human papilloma virus - overview

Kaposi’s sarcoma - overview

Herpes - overview