Briefly, race has been shown to modify the association between bacterial vaginosis and incident STI.25 One study found that certain cytokine and chemokine single-nucleotide polymorphisms were associated with ethnicity among HIV-infected individuals. The authors hypothesized ALK inhibitor that heritable variations in certain of these loci may contribute

to the acquisition or progression of HIV infection.26 Further, the concept of race is a complicated one. The National Institutes of Health has historically used self-identified racial categories. Individual patients frequently do not self-identify with one of these categories and thus are classified as ‘other’. A newer technology uses single-nucleotide polymorphisms to create families of ethnic derivation called ancestry informative markers.27 These require obtaining biologic samples and laboratory work by a reputable facility so are not used frequently. However, if race is an important component of an individual HIV risk study, consideration

can be given to collection of more detailed ethnicity data. There exists a vast body of literature detailing the association between genital tract infections and HIV acquisition find more and transmission. Much recent work has focused on herpes simplex virus-2 (HSV2) given the ulcerative and inflammatory nature of the infection and the high prevalence of the infection. If having HSV2 impacts shedding of HIV and the risk of transmission, then curbing the

shedding caused by this infection alone might decrease the burden of HIV infection worldwide. Herpes simplex virus-2 has been shown to increase viral load of HIV in both plasma and the genital tract, independent of the level of immunodeficiency.28 The etiology of increased shedding of HIV in the presence of HSV appears to be immunologically mediated. Rebbapragada et al.29 termed the interaction between HSV2 and HIV-1 ‘negative mucosal synergy’. While HSV suppression appears to decrease the risk of shedding HIV among women already infected with HIV, it does not appear to protect against acquisition or transmission of HIV-1.30,31 Herpes simplex virus-2 is not the only infection that alters mucosal immune handling of HIV. A less noticed but still not highly prevalent virus that may impact on genital shedding of HIV is human cytomegalovirus (CMV). The prevalence of CMV varies by geographical location, but after infection, it establishes lifelong latency. It can reactivate or hosts can be re-infected. A group well known for their CMV expertise recently developed a cervical explant study of CMV and HIV co-infection. They found that HIV appeared to enhance CMV in co-infected tissues which produced inflammatory cytokines. This explant model may be a useful tool for future studies examining the impact of CMV on HIV expression and vice versa.32 Frequently encountered STI have also been implicated in altering mucosal immunity.