HIV and HSV-2 Infections in Persons Who Use Drugs in the United States

background: Reducing sexual transmission of HIV and HSV-2 among persons who use drugs (PWUD) -- heroin, cocaine, “speedball,” crack, methamphetamine, by injection or non-injection -- necessitates relevant strategies, especially because HSV-2 affects HIV acquisition, transmission, and disease progression.

methods: We assessed HSV-2 and HIV sero-prevalence in PWUD and identify clinical and public health strategies. We systematically reviewed U.S.-based studies, 1995 – 2014, on HSV-2 and HSV-2/HIV sero-epidemiology in PWUD and related interventions and services.

results: Eleven studies provided serologic test results. High HSV-2 sero-prevalence for PWUD (range across studies for men and women 38%–75%), higher HSV-2 sero-prevalence in women who use drugs (range across studies 59% -86%), and higher HSV-2 sero-prevalence in HIV-infected women than in women who were not (97% -100% and 68% - 82%, respectively) and in HIV-infected men (61-74%) were reported. HSV-2 strategies and future research for PWUD can include assessing effectiveness of HSV-2 screening or testing; increased awareness of HSV-2 status and importance of partner disclosure; education and counseling; developing and evaluating HSV-2 psychosocial risk-reduction interventions; treating genital herpes; and offering HIV antiretroviral medications for HSV-2/HIV co-infected PWUD.

conclusions: HSV-2 prevalence is high among PWUD, particularly among women who use drugs and those who are HIV-infected. New studies with PWUD on prevention effectiveness and cost-effectiveness of interventions and services for HSV-2 and HSV-2/HIV co-infections can inform program implementation and reduce infection and disparities. Treating PWUD for HSV-2 and HIV infections can build on current scientific knowledge including using effective medications for genital herpes and HIV/AIDS.