Over 13% of the global population, 491 million people, are living with herpes simplex virus type 2 (HSV-2) infection. Because genital herpes infection is lifelong, it is expected to be very costly, as well as significantly impact patient quality-of-life.
A paper recently published in PLOS Medicine sought to provide one of the first estimates of economic losses due to genital herpes, and HIV attributable to HSV-2, in 90 low- and middle-income countries (LMIC).
Specifically, the investigators wanted to find the size of direct and indirect economic losses, the significance of the quality-of-life losses, and the geographies in which these losses are most concentrated.
“HSV’s low threshold for transmission, high rates of seroprevalence, and broad spectrum of clinical diseases and psychosocial and psychosexual sequalae, suggest that it may underlie substantial economic and quality-of-life losses,” the study authors wrote.
In high-income countries, estimates of economic loss due to HSV-2 are widely variable and do not account for costs outside of treatment and productivity. However, it is vital to acknowledge the social and psychological impacts of HSV-2.
The investigators estimated genital herpes-related spending on treatment, wage losses due to absenteeism, and reductions in quality-of-life for individuals aged 15-49 years and living with HSV-2.
Equally important is considering coinfection of HSV-2 and HIV; in sub-Saharan Africa, as many as 80% of people living with HIV are seropositive for HSV-2. Thus, the investigators completed a separate estimate for instances in which HSV-2 contributed to HIV transmission.
They calculated estimates of HSV-2 incidence and prevalence from global burden of disease studies. For cases of HSV-2 and HIV coinfection, the investigators calculated population attributable fractions using Levin’s epidemiological formula for polytomous exposures. To extend estimated HSV-2 infections from 2020 to 2030, they utilized transmission models from 45 African countries.
In the 90 LMICs, HSV-2 contributed to $813.5 million in treatment and productivity losses in 2019. Considering observed care-seeking and absenteeism, economic losses are expected to range from $25.6-34.5 billion. Quality-of-life losses are expected to reach $61.7 million quality-adjusted life years.
For each individual HSV-2 infection, the average annual cost of treatment and wage losses is $183, while the average annual cost of quality-of-life loss is $343.27.
If HSV-2 fueled HIV transmission, seroprevalent HSV-2 infections in 2018 account for 33.2% of new HIV infections in 2019. This in turn contributed to an estimated antiretroviral therapy (ART) cost of $186.3 million, and 28.6% of HIV-related wage losses.
These estimated losses are even more troubling considering genital herpes infections are projected to increase over the next 15 years. Notably, quality-of-life losses were more costly than losses in treatment and productivity.
The investigators noted that the COVID-19 pandemic diverted our attentions, but we must return to development in other areas of infectious disease. Genital herpes can be very detrimental to quality-of-life, but it does not just affect the individual. HSV-2 causes a substantial economic burden, especially in low- and middle-income countries. Considering all the current and projected losses, an HSV-2 vaccine should be a top global priority.
