Herpesvirus infection of eye and brain in HIV infected patients

• Published in: Sexually transmitted infections Vol. 76; no. 4; pp. 282 - 286
• Main Authors: Miller, Robert F, Howard, Mark R, Frith, Peggy, Perrons, Christopher J, Pecorella, Irene, Lucas, Sebastian B
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01-08-2000; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; AIDS/HIV; Biological and medical sciences; Brain Diseases - diagnosis; Brain Diseases - virology; CMV retinitis; Cytomegalovirus; Cytomegalovirus Retinitis - diagnosis; DNA detection; Eye Infections, Viral - diagnosis; Female; Herpesviridae - isolation & purification; Herpesviridae Infections - diagnosis; herpesviruses; HIV; HIV Infections - complications; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Male; Medical sciences; Middle Aged; necropsy; Original; Pathology; Polymerase Chain Reaction - methods; Prospective Studies; Sensitivity and Specificity; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Infection; Human; Eye; Immunopathology; Opportunistic infection; Eye disease; Viral disease; Central nervous system disease; Herpes; AIDS; Immune deficiency; Brain (vertebrata)
• ISSN: 1368-4973; 1472-3263
• DOI: 10.1136/sti.76.4.282

Objectives: To compare histological with genome detection methods for diagnosis of herpesvirus infection in eye and brain of HIV infected patients undergoing necropsy and to correlate these findings with both antemortem clinical findings and postmortem evidence of extraocular herpesvirus infection, especially in the CNS. Methods: A prospective study of 31 consecutive HIV infected patients undergoing necropsy. In life 11 patients had been assessed by an ophthalmologist because of ocular symptoms. Ocular and brain samples were examined for herpesviruses by conventional histological methods and by nested polymerase chain reaction (nPCR) for all eight human herpesviruses; evidence of extraneural herpesvirus infection was sought by histological methods. Results: Although only 12 out of 31 patients (39%) had antemortem clinical evidence of ocular or CNS herpesvirus associated disease, herpesviruses were detected by nPCR in eye and brain from 26 (84%) patients; six patients had more than one herpesvirus infection. There was concordance between ocular and CNS findings in 15 of 19 patients (79%) with CMV infection. 17 of 31 patients (55%) had extraocular or CNS CMV infection at necropsy. Genome detection using nPCR was superior to histological methods for diagnosis of ocular and CNS herpesvirus infection. Conclusion: Herpesvirus infection of eye and brain was a frequent finding at necropsy in this group of HIV infected patients; almost a fifth were co-infected by more than one herpesvirus. This was more than twice the incidence predicted from clinical evidence before death. Genome detection using nPCR was superior to histological methods for diagnosis of ocular and CNS herpesvirus infection.