Human Herpesviruses as Copathogens of HIV Infection, Their Role in HIV Transmission, and Disease Progression

Of eight human herpesviruses (HHVs), often, only herpes simplex virus types 1 (HSV-1) and 2 (HSV-2) find mention in medical literature as both of these viruses are commonly associated with genital lesions and oral ulcers, commonly known as cold sores. However, role of human herpesviruses as copathogens and in aggravation and in the transmission of other human diseases, especially the Acquired immunodeficiency syndrome (HIV/AIDS) has only very recently been recognized. 

Therefore, screening and treating subclinical HHV infections may offer slowing of HIV infection, disease progression, and its transmission. Beside HSV-1 and HSV-2, HHV-3 a causative agent of herpes zoster remained one of the first manifestations of HIV disease before the era of highly active antiretroviral therapy (HAART). HHV-5 also known as human Cytomegalovirus infection remains a significant risk factor for HIV-associated mortality and morbidity even in HAART era. It is proposed that Cytomegalovirus viremia could be a better predictor of HIV disease progression than CD4+ T-lymphocyte count. The role of HHV-4 or Epstein-Burr virus and HHV-6, HHV-7, and HHV-8 is still being investigated in HIV disease progression. 

This review provides insight into the current understanding about these 8 HHVs, their co-pathogenesis, and role in HIV/AIDS disease progression. The review also covers recent literature in favor and against administering anti-HHV treatment along with HAART for slower AIDS progression and interrupted sexual transmission.

Below:  Opportunistic infections associated with advanced human immunodeficiency virus disease

Below:  The interaction between human herpesviruses and human immunodeficiency virus

Full article at:   http://goo.gl/3xJU69

By:  Munawwar A1, Singh S1.

• 1Department of Laboratory Medicine, Division of Clinical Microbiology and Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India. 
• J Lab Physicians. 2016 Jan-Jun;8(1):5-18. doi: 10.4103/0974-2727.176228.

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Incidence of Co-Infections of HIV, Herpes Simplex Virus Type 2 and Syphilis in a Large Cohort of Men Who Have Sex with Men in Beijing, China

BACKGROUND:

The HIV-epidemic among MSM in China has worsened. In this key population, prevalence of HSV-2 and syphilis infection and co-infection with HIV is high.

METHODS:

A longitudinal study was conducted (n = 962) in Beijing, China, with three overlapping cohorts (n = 857, 757 and 760) consisting of MSM that were free from pairs of infections of concern (i.e. HIV-HSV-2, HIV-syphilis, HSV-2-syphilis) at baseline to estimate incidence of HIV, HSV-2, syphilis, and those of co-infection.

RESULTS:

The incidence of HIV, HSV-2 and syphilis in the overall cohort was 3.90 (95% CI = 2.37, 5.43), 7.87 (95% CI = 5.74, 10.00) and 6.06 (95% CI = 4.18, 7.94) cases per 100 person-years (PYs), respectively. The incidence of HIV-HSV-2, HIV-Syphilis and HSV-2-Syphilis co-infections was 0.30 (95% CI = 0.29, 0.88), 1.02 (95% CI = 0.13, 2.17) and 1.41 (95% CI: 0.04, 2.78) cases per 100 PYs, respectively, in the three sub-cohorts constructed for this study.

CONCLUSIONS:

The incidence of HIV, HSV-2 and syphilis was very high and those of their co-infections were relatively high. Such co-infections have negative impacts on the HIV/STI epidemics. Prevention practices need to take such co-infections into account.

Below:  Associations of the socio-demographic characteristic with loss of follow-up among MSM in Beijing, China

Full article at:   http://goo.gl/TrgSPE

By:  Li D1, Yang X1,2, Zhang Z1, Wang Z2, Qi X1, Ruan Y3, Zhou Y4, Li C2, Luo F1, Lau JT2.

• 1Chaoyang Center for Disease Control and Prevention, Beijing, PR China.
• 2Center for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong SAR, Hong Kong, China.
• 3State Key Laboratory for Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China.
• 4Department of Epidemiology and Health Statistics, School of Public Health, Soochow University, Suzhou, Jiangsu, China.
• PLoS One. 2016 Jan 28;11(1):e0147422. doi: 10.1371/journal.pone.0147422. eCollection 2016. 

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High Levels of Persistent Problem Drinking in Women at High Risk for HIV in Kampala, Uganda

The aim of this study was to describe the epidemiology of problem drinking in a cohort of women at high-risk of HIV in Kampala, Uganda. 

Overall, 1027 women at high risk of HIV infection were followed from 2008 to 2013. The CAGE and AUDIT questionnaires were used to identify problem drinkers in the cohort. Interviewer-administered questionnaires were used to ascertain socio-demographic and behavioural factors. Blood and genital samples were tested for HIV and other sexually transmitted infections. 

At enrollment, most women (71%) reported using alcohol at least weekly and about a third reported having drunk alcohol daily for at least 2 weeks during the past 3 months. Over half (56%) were problem drinkers by CAGE at enrollment, and this was independently associated with vulnerability (being divorced/separated/widowed, less education, recruiting clients at bars/clubs, and forced sex at first sexual experience). 

Factors associated with problem drinking during follow-up included younger age, meeting clients in bars/clubs, number of clients, using drugs and HSV-2 infection. HIV prevalence was associated with drinking at enrollment, but not during follow-up. 

This longitudinal study found high levels of persistent problem drinking. Further research is needed to adapt and implement alcohol-focused interventions in vulnerable key populations in sub-Saharan Africa.

Full article at:   http://goo.gl/yT7hIa

By:  Weiss HA1, Vandepitte J2, Bukenya JN3, Mayanja Y4, Nakubulwa S5, Kamali A6, Seeley J7,8, Grosskurth H9.

• 1MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK. helen.weiss@lshtm.ac.uk.
• 2Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Entebbe, Uganda. jvdpitte@hotmail.co.uk.
• 3Department of Community Health and Behavioral Sciences, School of Public Health, Colleges of Health Sciences, Makerere University, Kampala, Uganda. jbukenya@musph.ac.ug.
• 4Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Entebbe, Uganda. yunia.mayanja@mrcuganda.org.
• 5Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Entebbe, Uganda. Susan.nakubulwa@mrcuganda.org.
• 6Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Entebbe, Uganda. anatoli.kamali@mrcuganda.org.
• 7Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Entebbe, Uganda. janet.seeley@lshtm.ac.uk.
• 8Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London WC1E 9RE, UK. janet.seeley@lshtm.ac.uk.
• 9MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK. heiner.grosskurth@lshtm.ac.uk. 
• Int J Environ Res Public Health. 2016 Jan 22;13(2). pii: E153. doi: 10.3390/ijerph13020153.

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Predictors of the Sexual Well-being of Individuals Diagnosed with Herpes and Human Papillomavirus

Research suggests that having a sexually transmitted infection (STI) such as genital herpes and human papillomavirus (HPV) can negatively affect sexual well-being. However, there is little research examining factors associated with poorer sexual well-being among individuals with a STI. 

This study investigated the extent to which stigma experiences, individual characteristics, and STI characteristics were associated with multiple aspects of sexual well-being among individuals diagnosed with herpes and/or HPV. Participants were an average of 36 years old (SD = 11.58) and included 188 individuals with herpes and/or HPV who completed measures of sexual activity, sexual problems, and sexual cognitive-affective factors. 

The results showed that experiences of stigmatization were the most important predictors of sexual well-being. Participants who perceived were stigmatized by others as well as those who internalized negative social attitudes to a greater extent reported poorer sexual well-being across all dimensions, over and above individual and STI characteristics. The implications of these findings for sexual health professionals are discussed.

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By:  Foster LR1, Byers ES2.

• 1Department of Psychology, University of New Brunswick, P.O. Box 4400, Fredericton, NB, E3B 5A3, Canada.
• 2Department of Psychology, University of New Brunswick, P.O. Box 4400, Fredericton, NB, E3B 5A3, Canada. byers@unb.ca.
• Arch Sex Behav. 2016 Feb;45(2):403-14. doi: 10.1007/s10508-014-0388-x. Epub 2014 Nov 19. 

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Sexual Risk and HIV Infection among Drug Users in New York City

Measures of sexual health were assessed during 2008–2009 in a New York City sample of 102 injection and noninjection users of heroin, cocaine, or crack. There was considerable overlap and transitioning between crack smoking and injecting. Crack users were also significantly more likely to be gay, lesbian, or bisexual than other drug users. In multivariate analysis, HIV infection was independently associated with crack use and with being gay or bisexual. In New York City, HIV prevention for drug users has focused on syringe access, safe injection, and drug user treatment, but further progress in HIV control will require strategies to address sexual health among people who use drugs. The study’s limitations are noted.

...The drug users recruited for this study would appear to be the ideal target of a sexual health intervention. Among the 102 drug users recruited in the first stage, 62% were eligible for the intervention; i.e., they reported recent unprotected sex with more than one partner. In this second-stage sample, 66% of NIDUs and 33% of IDUs were HIV positive, and only 64% of HIV positives were aware of their status. In addition, 75% had antibody to HSV-2, and only 12% had ever been told they had genital herpes. Thus, this method of recruitment led to a set of individuals who may greatly benefit from an intervention that seeks to reduce both HIV acquisition and transmission to uninfected partners and among whom efforts to address HSV-2 facilitation of HIV acquisition and transmission may be particularly important. The high prevalence of HSV-2 in this population is very similar to the rate (60%) observed in another New York City study of drug users and to the rates reported in other studies of crack users (Des Jarlais, Hagan, et al., 2007; Jones et al., 1998;Ross, Hwang, Leonard, Teng, & Duncan, 1999). Although it is understood that HSV-2 facilitates HIV transmission, it is unclear at this stage how to manage HSV-2 infection to reduce this risk (Celum et al., 2010).

The high prevalence of HIV in this sample was unexpected, as it was substantially higher than rates observed in other New York City studies of opiate users of 15%–20% (Des Jarlais, Arasteh, et al., 2007). The sample was also unique in the degree to which injectors, former injectors, noninjectors, and sexual minorities overlapped. Gay, lesbian, and bisexual participants were more likely to be crack users than were heterosexuals, and bisexuals were more likely to be involved in sex trade. As noted by Des Jarlais et al. in this issue, many injectors in New York City have stopped injecting and returned to smoking or inhaling drugs. This transition to noninjection drug use may have led to new social and sexual linkages between former injectors with high HIV prevalence and lower-prevalence noninjection users. Crack use, along with the buying and using of other drugs, may create linkages between sexual minorities and heterosexuals in New York. Crack use, in particular, appears to identify very high-risk subsets of drug users in New York City. This finding of great overlap between gay, lesbian, bisexual, and heterosexual injection and noninjection users of heroin and cocaine has several implications for the development of interventions, including that strategies should use social, sexual, and drug-use-related linkages to locate and intervene with persons at high risk of HIV acquisition and transmission. In addition, interventions should address multiple sources of risk for HIV exposure in a linked population...

Below:  Diagram showing relative overlap among drug injection, crack cocaine use, and gay or bisexual orientation among heroin and cocaine users, New York City

Full article at:   http://goo.gl/9zI5A0

By:   Holly Hagan,1 David C. Perlman,2 and Don C. Des Jarlais3

¹College of Nursing, New York University, New York, New York, USA

²Department of Medicine, Beth Israel Medical Center, New York, New York, USA

³Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, USA

Address correspondence to Dr. Holly Hagan, New York University College of Nursing, 726 Broadway, 10th Floor, New York, NY 10003; Email:ude.uyn@05hh

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Prevalence of Seven Sexually Transmitted Organisms by Multiplex Real-Time PCR in Fallopian Tube Specimens Collected from Saudi Women With & Without Ectopic Pregnancy

BACKGROUND:

Ectopic pregnancy (EP) is associated with maternal morbidity and occasionally mortality during the first trimester. A history of sexually transmitted infection (STI) and pelvic inflammatory disease have been implicated as major risk factors for EP. Our aim was to measure the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae, Mycoplasma genitalium (MG), Ureaplasma parvum/urealyticum, Gardnerella vaginalis, Trichomonas vaginalis and herpes simplex virus (HSV)-1&2 in Fallopian tubes collected from EP and the results were compared with those obtained from total abdominal hysterectomy (TAH) and tubal ligation.

METHODS:

This was a prospective case-control study and tubal samples were collected from 135 Saudi women recruited from 3 centres in the Western region as follow: 84 EPs, 20 TAH and 31 tubal ligations. Multiplex TaqMan PCR was performed using an IVD CE kit for the simultaneous detection of candidate pathogens following DNA extraction.

RESULTS:

Infections were detected in 31.8 % of the 135 participants either as single (11.1 %) or co-infections (20.7 %) and the frequencies were significantly higher in EP (42.85 %) compared with control (13.72 %). The rates of CT (27.4 %; P = 0.001); MG (20.2 %; P = 0.009) and HSV-1/2 (21.4 %; P = 0.01) were significantly higher in EP. No significant difference between the study groups was observed for the other pathogens (P > 0.05). Binary logistic regression also showed that infection with ≥ 2 pathogens (OR 4.9; 95 % CI: 2.2 - 11.6; P = 0.006), CT (OR 3.07; 95 % CI: 1.3 - 12.3; P = 0.002), MG (OR 2.3; 95 % CI: 1.1 - 8.6; P = 0.03) and HSV-1/2 (OR 1.7; 95 % CI: 0.75 - 5.7; P = 0.004) were associated with a significantly higher risk of developing EP.

CONCLUSIONS:

STIs are frequent in the upper genital tract of Saudi women during the reproductive age and, CT, MG and HSV-1/2 were more prevalent in EP. The observed high rates of co-infection advocate the necessity of establishing national guidelines and/or screening program utilising multiplex PCR approach for the detection of common STIs among high risk groups in the kingdom. Further studies are needed to measure the adverse reproductive outcomes associated with STIs in Saudi Arabia.

Table 1

Principle inclusion and exclusion criteria for the study groups

Control group		Case group
Inclusion criteria	Exclusion criteria	Inclusion criteria	Exclusion criteria
Saudi	Non-Saudi	Saudi	Non-Saudi
Patient age ≥ 18 and ≤ 42 years.	Patient age < 18 or > 42 years.	Patient age ≥ 18 and < 40 years.	Patient age < 18 or > 40 years.
Cyclic women with a history of previous intrauterine pregnancy and no history of hydrosalpinx or ectopic pregnancy	Women with abnormal menstrual cycle, history of infertility treatment, history of PID, endometriosis and previous ectopic pregnancy.	Ectopic pregnancy following spontaneous conception	Ectopic pregnancy following assisted conception, using IUD, History/symptoms of urogenital infection (e.g. vaginal discharge, dysuria, PID, etc.)
Clinical decision to undertake total abdominal hysterectomy (TAH) for benign disease not affecting the Fallopian tubes and endometrium	Vaginal or subtotal hysterectomy	Singleton pregnancy	Multiple/heterotopic pregnancy
Clinical decision to undertake tubal ligation for sterilisation	Use of IUD ≤ 1 year prior to operation	Clinical determination that the patient is haemodynamically stable	Symptoms and signs of hypovolemia

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By:   Ashshi AM1, Batwa SA2, Kutbi SY3, Malibary FA4, Batwa M5, Refaat B6.

• 1Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, Makkah, PO Box 7607, KSA. aashshi@yhaoo.com.
• 2Obstertics and Gynaecology Department, Maternity and Children Hospital, Al-Aziziyah, Jeddah, KSA. sarahbatwa@hotmail.com.
• 3Obstertics and Gynaecology Department, Maternity and Children Hospital, Al-Aziziyah, Jeddah, KSA. seham.alkutbi@yahoo.com.
• 4Obstertics and Gynaecology Department, Maternity and Children Hospital, Al-Aziziyah, Jeddah, KSA. fzmilly12345@gmail.com.
• 5Al-Thager General Hospital, Jeddah, KSA. mbatwa@hotmail.com.
• 6Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Al Abdeyah, Makkah, PO Box 7607, KSA. bassem.refaat@yahoo.co.uk. 

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Effect of Condom Use on Per-act HSV-2 Transmission Risk in HIV-1, HSV-2-discordant Couples

BACKGROUND:

The efficacy of condoms for protection against transmission of herpes simplex virus type 2 (HSV-2) has been examined in a variety of populations with different effect measures. Often the efficacy has been assessed as change in hazard of transmission with consistent vs inconsistent use, independent of the number of acts. Condom efficacy has not previously measured on a per-act basis.

METHODS:

We examined the per-act HSV-2 transmission rates with and without condom use among 911 African HSV-2 and human immunodeficiency virus type 1 (HIV-1) serodiscordant couples followed for an average of 18 months in an HIV prevention study. Infectivity models were used to associate the log₁₀ probability of HSV-2 transmission over monthly risk periods with reported numbers of protected and unprotected sex acts. Condom efficacy was computed as the proportionate reduction in transmission risk for protected relative to unprotected sex acts.

RESULTS:

Transmission of HSV-2 occurred in 68 couples, including 17 with susceptible women and 51 with susceptible men. The highest rate of transmission was from men to women: 28.5 transmissions per 1000 unprotected sex acts. We found that condoms were differentially protective against HSV-2 transmission by sex; condom use reduced per-act risk of transmission from men to women by 96% (P < .001) and marginally from women to men by 65% (P = .060).

CONCLUSIONS:

Condoms are recommended as an effective preventive method for heterosexual transmission of HSV-2.

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By:  Magaret AS1, Mujugira A2, Hughes JP3, Lingappa J4, Bukusi EA5, DeBruyn G6, Delany-Moretlwe S7, Fife KH8, Gray GE9, Kapiga S10, Karita E11, Mugo NR5,Rees H7, Ronald A12, Vwalika B13, Were E14, Celum C15, Wald A16; Partners in Prevention HSV/HIV Transmission Study Team.

• 1Department of Laboratory Medicine Department of Biostatistics Department of Global Health.
• 2Department of Global Health Department of Epidemiology, University of Washington.
• 3Department of Biostatistics Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center.
• 4Department of Global Health Department of Pediatrics Department of Medicine, University of Washington, Seattle.
• 5Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi.
• 6Sanofi Pasteur, Swiftwater, Pennsylvania.
• 7Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.
• 8Department of Medicine, Indiana University, Indianapolis.
• 9Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
• 10London School of Hygiene and Tropical Medicine, United Kingdom.
• 11Rwanda-Zambia HIV Research Group, Kigali, Rwanda, Lusaka, Zambia.
• 12Department of Medicine, University of Manitoba, Winnipeg, Canada Infectious Disease Institute, Makerere University, Kampala, Uganda.
• 13Rwanda-Zambia HIV Research Group, Kigali, Rwanda, Lusaka, Zambia Department of Obstetrics and Gynaecology, University of Zambia, School of Medicine, Lusaka.
• 14Department of Reproductive Health, Moi University, Eldoret, Kenya.
• 15Department of Global Health Department of Epidemiology, University of Washington, Department of Medicine, University of Washington, Seattle.
• 16Department of Laboratory Medicine Department of Epidemiology, University of Washington, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center Department of Medicine, University of Washington, Seattle. 

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Current Concepts for Genital Herpes Simplex Virus Infection: Diagnostics and Pathogenesis of Genital Tract Shedding

Herpes simplex virus 2 (HSV-2) is a DNA virus that is efficiently transmitted through intimate genital tract contact and causes persistent infection that cannot be eliminated. HSV-2 may cause frequent, symptomatic self-limited genital ulcers, but in most persons infection is subclinical. 

However, recent studies have demonstrated that the virus is frequently shed from genital surfaces even in the absence of signs or symptoms of clinical disease and that the virus can be transmitted during these periods of shedding. Furthermore, HSV-2 shedding is detected throughout the genital tract and may be associated with genital tract inflammation, which likely contributes to increased risk of HIV acquisition. 

This review focuses on HSV diagnostics, as well as what we have learned about the importance of frequent genital HSV shedding for (i) HSV transmission and (ii) genital tract inflammation, as well as (iii) the impact of HSV-2 infection on HIV acquisition and transmission. 

We conclude with discussion of future areas of research to push the field forward.

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By: Johnston C1, Corey L2.

• 1Department of Medicine, University of Washington, Seattle, Washington, USA Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA cjohnsto@u.washington.edu.
• 2Department of Medicine, University of Washington, Seattle, Washington, USA Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. 

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Herpes Simplex Virus Type-2 (HSV-2) Cervico-Vaginal Shedding among Women Living with HIV-1 on Antiretroviral Therapy in Burkina Faso

The impact of antiretroviral therapy (ART) on herpes simplex virus type-2 (HSV-2) replication is unclear. The aim of this study was to assess factors associated with cervico-vaginal HSV-2 DNA shedding and genital ulcer disease (GUD) in a cohort of women living with HIV-1 in Burkina Faso.

Participants were screened for cervico-vaginal HSV-2 DNA, GUD, cervico-vaginal and systemic HIV-1 RNA and reproductive tract infections every 3-6 months over 8 years. Associations with HSV-2 shedding and quantity were examined using random effects logistic and linear regression, respectively.

Of the 236 women with data on HSV-2 shedding, 151 took ART during the study period. Cervico-vaginal HSV-2 DNA was detected in 42% (99/236) of women in 8.2% of visits (151/1848). ART was associated with a reduction in HSV-2 shedding which declined for each year on ART. In the multivariable model, the impact of ART was primarily associated with suppression of systemic HIV-1 RNA. A reduction in GUD was also observed while on ART, mainly in those with HIV-1 viral suppression.

ART is strongly associated with a decrease in cervico-vaginal HSV-2 shedding, and the impact was sustained over several years.

Full article at: http://goo.gl/e4HS5v

By: Low AJ1, Nagot N2, Weiss HA1, Konate I3, Kania D3, Segondy M2, Meda N3, van de Perre P2, Mayaud P1.

• 1London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
• 2UMR 1058 University of Montpellier & Montpellier University Hospital F-34295 Montpellier, France.
• 3Centre Muraz, Bobo-Dioulasso, 01 BP 390, Burkina Faso.  

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Semi-Parametric Spatial Joint Modeling of HIV and HSV-2 among Women in Kenya

Below:  Residual spatial effect of county on HIV

Below:  Residual spatial effect of county on HSV-2

Several diseases have common risk factors. The joint modeling of disease outcomes within a spatial statistical context may provide more insight on the interaction of diseases both at individual and at regional level. Spatial joint modeling allows for studying of the relationship between diseases and also between regions under study. One major approach for joint spatial modeling is the multivariate conditional autoregressive approach. In this approach, it is assumed that all the covariates in the study have linear effects on the multiple response variables. In this study, we relax this linearity assumption and allow some covariates to have nonlinear effects using the penalized regression splines. This model was used to jointly model the spatial variation of human immunodeficiency virus (HIV) and herpes simplex virus-type 2 (HSV-2) among women in Kenya. The model was applied to HIV and HSV-2 prevalence data among women aged 15–49 years in Kenya, derived from the 2007 Kenya AIDS indicator survey. A full Bayesian approach was used and the models were implemented in WinBUGS software. Both diseases showed significant spatial variation with highest disease burdens occurring around the Lake Victoria region. There was a nonlinear association between age of an individual and HIV and HSV-2 infection. The peak age for HIV was around 30 years while that of HSV-2 was about 40 years. A positive significant spatial correlation between HIV and HSV-2 was observed with a correlation of 0.6831(95% CI: 0.3859, 0.871).

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