Background:  We examined the burden of and risk factors for viral infections in a large cohort of women. 

Methods:  871 HIV-infected and 439 high-risk HIV-uninfected women aged 16-55 from 4 U.S. cities were enrolled in the HIV Epidemiology Research (HER) study from 1993 to 1995.  Serum antibody tests were done for cytomegalovirus (CMV), hepatitis B core antigen (HBV), and hepatitis C virus (HCV), human herpesvirus 8 (HHV-8), and herpes simplex virus types 1 & 2 (HSV-1, HSV-2).  Human papillomavirus (HPV) was detected by PCR from cervicovaginal lavage specimens.  Data were analyzed using χ² tests and logistic regression. 

Results:  The prevalence of viral infections was higher among HIV-infected women (Table 1), of whom 60.4% had at least 4 of the other infections and 39.2% had at least 5.  After controlling for demographics, injection-drug use (IDU), and sexual behavior, women with evidence of having had more infections (≥5 vs <5) were more likely to be HIV-infected (OR_adj=2.0, 95% CI=1.4-2.9).  HPV had the strongest association with HIV (OR_adj= 6.3, 95% CI 3.8-10.5).  Age was strongly associated with HBV and HCV, and moderately associated with HSV-2.  Other factors significantly associated with infection in univariate analyses are shown in Table 2.

 

Table 1. Prevalence of Different Viral Infections According to HIV Status.

	CMV	HBV	HCV	HHV-8	HSV-1	HSV-2	HPV
HIV+ women	94.6%	58.9%	60.8%	17.8%	74.6%	67.7%	63.8%
HIV- women	88.7%	42.4%	48.0%	12.6%	74.6%	56.5%	27.4%

 
Table 2. Risk Factors Significantly Associated with Infection, Odds Ratio (95% CI).

	CMV	HBV	HCV	HSV-1	HSV-2
< HS educ	2.2 (1.4-3.6)	1.7 (1.3-2.1)	1.7 (1.4-2.2)	1.8 (1.4-2.4)	1.5 (1.2-1.9)
Black race	4.1 (2.6-6.5)	1.4 (1.1-1.8)			1.8 (1.4-2.2)
Cmmr sex	2.7 (1.6-4.7)	2.3 (1.8-2.9)	2.1 (1.6-2.6)		1.5 (1.2-1.9)
IDU		12 (9-16)	75 (52-107)

Conclusions:  The burden of viral infection in these women was high, and being infected with HIV significantly increased the risk of having more infections.  Disadvantaged women and women with high-risk behavior were more likely to have additional viral infections.