Herpes simplex virus (HSV) infection is common in persons coinfected with human immunodeficiency virus (HIV). In a prospective study, daily viral cultures of the mouth, genitals, and rectum were collected from 68 HIV- positive and 13 HIV-negative men who have sex with men. Subjects completed a median of 57 days of follow-up. Anogenital HSV-2 cultures were positive on 405 (9.7%) of 4167 days for HIV-positive men and on 24 (3.1%) of 766 days for HIV-negative men. Most reactivations were perirectal and subclinical. Risk factors for increased HSV-.2 shedding among HIV-positive men were low CD4 cell count (odds ratio, 2.5; 95% confidence interval, 1.2-5.4) and antibodies to both HSV-1 and HSV-2 versus HSV-2 only (odds ratio, 1.9; 95% confidence interval, 1.0-3.7). Three isolates obtained from 3 separate subjects were resistant to acyclovir. Thus, subclinical HSV-2 reactivation is an important opportunistic infection in persons with HIV infection. Further studies are necessary to determine the impact of subclinical HSV-2 reactivation on the natural history of HIV infection.
Bibliographical noteFunding Information:
Received 12 January 1998; revised 4 June 1998. The study protocol was approved by the University of Washington Institutional Review Board. Financial support: NIH (AI-30731, AI 01338; AIDS Clinical Trials Group grant AI-27664). Reprints: Dr. Larry Corey, Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, 1124 Columbia St., M-115, Seattle, WA 98104. Correspondence: Dr. Timothy Schacker, University of Minnesota, Dept. of Medicine, Box 250, 516 Delaware St. SE, Minneapolis, MN 55455 (schac008@Lenti.med.umn.edu).
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