Trends of HIV/Syphilis/HSV-2 seropositive rate and factors associated with HSV-2 infection in men who have sex with men in Shenzhen, China: A retrospective study

PLOS ONE RESEARCH ARTICLE Trends of HIV/Syphilis/HSV-2 seropositive rate and factors associated with HSV-2 infection in men who have sex with men in Shenzhen, China: A retrospective study Sha-Sha Mao1,2, Shui-Dong Feng1, Chen-Li Zheng2, Wei Hu3, Hao Li2, Jie Tang1,2, ZhengRong Yang1,2*, Jin Zhao ID2* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 School of Public Health, University of South China, Hengyang, Hunan, China, 2 Department of HIV/AIDS Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong, China, 3 Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China * (JZ); (ZRY) Abstract OPEN ACCESS Citation: Mao S-S, Feng S-D, Zheng C-L, Hu W, Li H, Tang J, et al. (2021) Trends of HIV/Syphilis/ HSV-2 seropositive rate and factors associated with HSV-2 infection in men who have sex with men in Shenzhen, China: A retrospective study. PLoS ONE 16(5): e0251929. https://doi.org/ 10.1371/journal.pone.0251929 Editor: Junjie Xu, China Medical University, CHINA Received: February 2, 2021 Accepted: May 5, 2021 Published: May 20, 2021 Copyright: © 2021 Mao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Funding: This work was funded by the National Natural Science Foundation of China (81573211 and 81270043), the National Key S&T Special Projects on Major Infectious Diseases (2018ZX10721102), Guangdong Basic and Applied Basic Research Foundation (2019B1515120003), San-Ming Project of Medicine in Shenzhen (SZSM201811071) and Shenzhen Key Medical Objectives To analyze the trends of HIV/syphilis/HSV-2 seropositive rate and explore the related factors with HSV-2 infection to provide the basis for adjusting STD intervention strategies and formulating prevention and control measures among MSM in Shenzhen. Methods Time-location sampling was conducted among MSM in Shenzhen in 2012, 2014, 2016, and 2018. Data on demographics, sexual behaviors and the laboratory test results of HIV, syphilis, HSV-2 were collected. The χ2 trend test was used to analyze the trends of HIV/syphilis/ HSV-2 seropositive rate. The binary logistic regression model was used to explore the factors associated with HSV-2 infection. Results The seropositive rate of HIV fell significantly from 15.9% in 2012 to 8.7% in 2018 (Ptrend = 0.003), syphilis seropositive rate was significantly decreased from 20.4% in 2012 to 14.8% in 2018 (Ptrend = 0.025), HSV-2 seropositive rate had no significant change (16.7% in 2012 to 14.0% in 2018; Ptrend = 0.617). In principal component logistic regression analysis showed that FAC1_1 (X1 = Ever had sex with female, X2 = Gender of first sexual partner, X3 = Marital status, X4 = Age group), FAC2_1 (X5 = Education, X6 = Monthly income (RMB), X7 = Frequency of condom use in anal sex with men in the past 6 months), and FAC4_1 (X9 = History of STDs) were significantly associated with HSV-2 infection. Conclusions The seropositive rates of HIV and syphilis have dropped significantly but are still high. HSV2 seropositive rate had no significant change and maintained a high level. It is necessary to PLOS ONE | https://doi.org/10.1371/journal.pone.0251929 May 20, 2021 1 / 16 PLOS ONE Discipline Construction Fund (SZXK064), Medical Scientific Research Foundation of Guangdong (A2019474), Shenzhen Health System Research Project (SZGW201810003). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. manuscript. Competing interests: The authors have declared that no competing interests exist. Trends of HIV/Syphilis/HSV-2 seropositive rate and factors associated with HSV-2 infection continue strengthening HIV and syphilis interventions among MSM in Shenzhen. HSV-2 detection and intervention are urgently required for MSM, which might be another effective biological strategy further to control the HIV epidemic among MSM in Shenzhen. Introduction The HIV epidemic is worsening among men who have sex with men (MSM) [1]. It is imperative to explore more effective methods that could curb the HIV epidemic in this population. Sexually transmitted diseases (STDs) such as syphilis and herpes simplex virus type 2 (HSV-2) are biological risk factors for HIV infection and transmission [2,3]. Therefore, it is essential to carry out STDs routine surveillance and intervention for MSM. In the past decade, the routine surveillance and intervention of STDs for MSM in China have focused on HIV, syphilis and Hepatitis C (HCV). In contrast, HSV-2 detection and intervention have not got much attention. HSV-2 infection is the leading cause of genital ulcer disease, one of the most common sexually transmitted diseases in the world [4]. MSM have high rates of HSV-2 infection, ranging from 8.7% to 65% in studies of different countries, especially in HIV positive MSM, which was more severe, ranging from 20.4% to 55.9% [5–9]. HSV-2 has a strong interaction with HIV, which can increase the risk of acquiring HIV by 2–4 fold and transmitting HIV by 2–5 fold, even promote the progression of HIV disease [3,10,11]. Most people infected with HSV-2 are asymptomatic but have virus shedding in the anogenital sites. Consequently, subclinical virus shedding of unrecognized and undiagnosed appear to be major factors in the spread of HSV-2 [12]. HSV-2 serum-specific antibody detection is of great significance in the early recognition and diagnosis of HSV-2 infection, particularly for atypical genital ulcer disease and asymptomatic carriers [13]. Currently, therapy of HSV-2 with acyclovir, famciclovir, or valacyclovir can reduce the recurrence of genital ulcers and the frequency of HSV-2 shedding. It can even decrease the level of HIV RNA in plasma and genital secretions, which may bring more clinical and public health benefits for patients with HIV-1 and HSV-2 coinfection [14]. Therefore, the detection and intervention of HSV-2 can be used as a biological strategy to control HIV infection and transmission, which may have a profound impact on the global HIV epidemic. Moreover, HSV-2 and HIV prevalence are strongly associated. HSV-2 prevalence can be used as a proxy ‘biomarker’ of HIV epidemic potential, acting as a ‘temperature scale’ of the intensity of sexual risk behavior that is difficult to measure directly [15]. Given these benefits, HSV-2 detection and intervention for MSM can track the intensity of sexual behavior, predict the epidemic potential of HIV, and even help control the HIV epidemic in MSM. With the continuous strengthening of the prevention and control of HIV and syphilis among MSM in Shenzhen, the prevalence of HIV and syphilis has decreased but is still higher than other (...truncated)