Genital Herpes and HIV Coinfection Can be Costly

A recent peer-reviewed study estimated economic and quality-of-life losses due to genital herpes in 90 low- and middle-income countries (LMICs), which can be extensive, especially considering the lifelong nature of herpes.

These researchers stated that even under the most conservative assumptions (1 visit per yr), economic losses due to genital herpes in LMICs could be as large as US$39 billion. 

This new study published by PLOS Medicine on December 15, 2022, estimated the future economic losses due to human immunodeficiency virus (HIV) attributable to herpes simplex virus type 2 (HSV-2) infections.

HSV-2 infection is linked to the acquisition of HIV, causing epidemiological synergy between these viruses.

And if HSV-2 has contributed to the spread of HIV in LMICs, then nearly one-third of antiretroviral costs and HIV-related wage losses can be attributed to HSV-2.

For the 90 LMICs included in the review, the researchers found for 2019:

• Herpes treatment costs and productivity losses were between US$674 and US$952 million.
• Quality-of-life losses ranged from 50 million to 74 million quality-adjusted life years.
• Seroprevalent HSV-2 cases accounted for about 33% of antiretroviral therapy costs for incident HIV cases and 28.6% of HIV-related wage losses.

Furthermore, a separate study published by The Lancet Europe on December 12, 2022, characterized HSV-2 seroprevalence in Europe for various at-risk populations and proportions of HSV-2 detection in genital ulcer disease (GUD) and genital herpes.

This study reported that HSV-2 accounts for approximately 20% of GUD cases and 66% of genital herpes cases. 

And the pooled mean herpes seroprevalence was 46% (95% CI: 40.1–51.8%) among people living with HIV and people in HIV-discordant couples, 

These researchers concluded although seroprevalence is declining, a significant proportion of Europe's population is infected with HSV-2.

Given the magnitude of the combined economic losses, and HSV-2 / HIV infections, these researchers wrote that a vaccine against HSV-2 must be a global priority.

As of December 29, 2022, the U.S. Food and Drug Administration (FDA) has not approved a vaccine for herpes or HIV.

However, BioNTech SE confirmed on December 21, 2022, that it had dosed the first patient with its investigational BNT163 herpes vaccine candidate designed to prevent genital lesions as part of a first-in-human Phase 1 clinical research study, the German vaccine maker said on Wednesday.

BNT163 targets HSV-2, the herpes simplex virus that causes genital herpes, and potentially HSV-1, which causes oral herpes and can lead to genital herpes.

The World Health Organization says HSV-2 infection is a life-long, incurable, sexually transmitted infection (STI) that is prevalent worldwide.

Although asymptomatic in most people, HSV-2 infection can cause adverse health outcomes, such as recurrent genital lesions and serious neonatal infections.

Additional information regarding herpes and HIV vaccine candidates is hyperlinked.

Disclosures: Both sets of researchers did not disclose industry-related conflicts of interest. The Qatar National Research Fund and the Biomedical Research Program at Weill Cornell Medicine in Qatar supported one study.