Study Models Economic and Quality-of-Life Burden of Genital Herpes

Although herpes simplex virus type 2 (HSV-2) is common and often considered innocuous, the economic and quality-of-life losses related to genital herpes infection in low- and middle-income countries (LMICs) may be substantial, a study published in PLOS Medicine estimates. Considering the magnitude of the projected losses, the study authors emphasize the need for a vaccine against HSV-2.

HSV-2 affects a significant portion of the global population, with more than 13% of people living with the virus as of 2016. HSV-2 has a low threshold for transmission and is thought to significantly increase the risk of acquiring and spreading HIV. If this is the case, a significant portion of HIV-related losses could possibly be attributed to HSV-2.

“Even though direct causality from HSV-2 to HIV is yet to be established beyond doubt, an estimate of the share of the economic burden of HIV that can be averted by targeting HSV-2 is still useful, more so now as efforts to contain the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus (coronavirus disease 2019 [COVID-19]) have had adverse impacts on HIV control programs,” the study authors wrote.

Indirect and direct economic and quality-of-life losses were estimated for individuals aged 15 to 49 years living in 90 LMICs in 2019 and in 45 World Health Organization (WHO) Africa region countries from 2020 to 2030. The model utilized to estimate transmission in WHO Africa region countries was adapted from a recent model of HSV-2 in the United States from 1950 to 2050. The study, to the authors’ knowledge, presents the first estimates of economic and quality-of-life losses related to genital herpes and HIV infections potentially attributable to HSV-2.

The estimated losses were substantial, with genital herpes attributed to between $674.4 million and $952.2 million in treatment and productivity losses in the 90 LMICs in 2019. Factoring in patient care-seeking habits and absenteeism, the losses attributed to genital herpes were estimated to be between $25.6 billion and $34.5 billion.

Potential quality-of-life losses due to genital herpes were 61.7 million (50.4 million to 74.2 million) quality-adjusted life years (QALYs) in 2019. The mean cost of treatment and wage losses per infection was $183.00, with an average annual cost of $343.27 in quality-of-life losses. If patients seek care per episode, the estimated total value of the QALYs lost would be $212 billion.

In 2019, a total of 522,477 (33.89%) incident HIV cases were attributable to incident and prevalent HSV-2 cases. Of the estimated antiretroviral therapy (ART)-related costs resulting from HIV cases, which amounted to $561.2 million, $186.4 million (33.2%) were related to incident and prevalent HSV-2 cases. The proportion of incident HIV cases resulting from incident HSV-2 infection was 2.2%. An estimated $21.9 million (28.6%) of HIV-related wage losses were attributable to HSV-2.

Depending on whether patients seek care once per year or per episode, incident and prevalent genital herpes infections could lead to between $32 million and $4 billion from 2020 to 2030 in the WHO Africa region, according to the study model. Between treatment and productivity losses, genital herpes cases in this timeframe would contribute to at least $700.2 million in losses in the model.

Regarding quality-of-life, the study estimates losses ranging from 33 million QALYs to 871 million QALYs. The population attributable fraction (PAF) of HIV due to prevalent HSV-2 will be 32.8% if HSV has contributed to HIV transmission, and the PAF due to incident infections will be 4.2%. These PAF estimates are consistent with previous research, according to the study authors.

“Our analysis provides compelling evidence that despite the commonly held notion that HSV-2 is an innocuous infection, it can lead to substantial economic losses in LMICs,” the authors concluded. “While the COVID-19 pandemic has understandably diverted attention from other disease control priorities, neglecting the most ubiquitous of all human infections will undoubtedly carry with it long-lasting economic and societal consequences.”

Reference

Silva S, Ayoub HH, Johnston C, Atun R, Abu-Raddad LJ. Estimated economic burden of genital herpes and HIV attributable to herpes simplex virus type 2 infections in 90 low- and middle-income countries: A modeling study. PLoS Med. 2022;19(12):e1003938. Published December 15, 2022. doi:10.1371/journal.pmed.1003938