Additional treatment and prevention interventions are needed to decrease the transmission of HIV from non-injecting drug users who have HSV-2/HIV coinfection, according to research published in PLoS One.

“The increase in HIV among these non-injecting drug users is better considered as an increase in HSV-2/HIV coinfection rather than simply an increase in HIV prevalence,” wrote Don C. Des Jarlais, PhD, of the Beth Israel Medical Center in New York, and colleagues.

To assess the association of HSV-2/HIV coinfection with the increase in HIV among non-injecting heroin and cocaine users in New York City, researchers studied patients treated at the Beth Israel Medical Center drug detoxification and methadone maintenance programs between 1995-1999 (n=785) and 2005–2011 (n=1,764).

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A questionnaire was administered and serum samples were gathered for HIV and HSV-2 testing. All study participants reported current heroin and/or cocaine use and no injection drug use. There were marked increases in the prevalence of HIV in the two cohorts from 7% to 13% for nearly all demographic subgroups.

For both time periods, 80% of HIV-negative females were infected with HSV-2 and 43% of HIV-negative males were infected with HSV-2. Among patients with HIV, HSV-2 prevalence was 97% in females and 67% in males.

“The increase in HIV prevalence was predominantly an increase in HSV-2/HIV coinfection, with relatively little HIV monoinfection in either time period,” wrote the investigators.

The estimates for population-attributable risk percentages suggest almost 50% of HIV acquisition among females was caused by HSV-2 infection, whereas roughly 60% of HIV transmission from females was due to HSV-2 coinfection.


  1. Jarlais D. PLoS ONE. 2014;doi:10.1371/journal.pone.0087993.