Herpes Simplex Virus-2 and HIV among Non-injecting Drug Users in New York City

Objective: To examine the relationship between herpes simplex virus-2 (HSV-2) seroprevalence and HIV seroprevalence among non-injecting heroin and cocaine users in New York City. HSV-2 infection increases both the likelihood of the acquisition and the transmission of HIV. Methods: 462 non-injecting cocaine and heroin users were recruited from a drug detoxification program in New York City. Smoking crack cocaine, intranasal use of heroin and intranasal use of cocaine were the most common types of drug use. A structured interview was administered and a serum sample was collected for HIV and HSV testing. Results: HIV prevalence was 19% and HSV-2 seroprevalence was 60%. The adjusted odds ratio for the association between HSV-2 and HIV was 2.01 (95% CI 1.15 to 3.53). The relationship between HSV-2 and HIV was particularly strong among females, among whom 86% were HSV-2 seropositive, 23% were HIV seropositive, and all HIV seropositives were also HSV-2 seropositive. Conclusions: HSV-2 appears to be an important factor in sexual transmission of HIV among non-injecting cocaine and heroin users in New York City, especially among females. The estimated population attributable risk for HIV infection attributable to HSV-2 infection in this sample was 38%. Programs to manage HSV-2 infection should be developed as part of comprehensive HIV prevention for non-injecting drug users.