Oral shedding of herpesviruses in HIV-infected patients with varying degrees of immune status. (24th September 2017)

• Record Type: Journal Article
• Authors: Dittmer, Dirk P.; Tamburro, Kristen; Chen, Huichao; Lee, Anthony; Sanders, Marcia K.; Wade, Tischan A.; Napravnik, Sonia; Webster-Cyriaque, Jennifer; Ghannoum, Mahmoud; Shiboski, Caroline H.; Aberg, Judith A.
• Is Part Of: AIDS. Volume 31:Number 15(2017)
• Publication Date: 2017-09-24
• Subjects: AIDS -- clinical trial -- cytomegalovirus -- Epstein–Barr virus -- herpesviruses -- HIV -- Kaposi sarcoma -- Kaposi sarcoma-associated herpesvirus -- oral hairy leukoplakia; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000001589
• Languages: English
• ISSNs: 0269-9370

Abstract

Abstract : Objective: Herpesvirus shedding in the oral cavity was analyzed to determine if presence in the oral compartment correlates with systemic changes in HIV-associated immune deficiency as measured by CD4 + cell counts, plasma HIV viral load and presence of AIDS-defining events. Design: A5254 is a multicenter, cross-sectional, single-visit study to evaluate oral complications of HIV/AIDS and determine the association between clinical appearance, herpesvirus shedding, and immune status as ascertained by CD4 + cell count and HIV viral load. In total, 307 HIV-infected individuals were evaluated and throat wash collected. Methods: Fisher's exact test and Kruskal–Wallis test were used to assess the association between presence of herpesviruses and the state of immunodeficiency as stratified by a combination of CD4 + cell count and HIV viral load. Relationship between pathogens and HIV viral load in plasma was modeled by logistic regression. Results: The presence of cytomegalovirus (CMV) and herpes simplex virus-1 in throat wash was associated with decreased CD4 + cell counts. By contrast, Kaposi sarcoma-associated herpesvirus and Epstein–Barr virus were similarly detectable across all levels of CD4 + cell counts. One unit increase in log10 (HIV viral load) was associated with 1.31 times higher odds of detecting CMV in throat wash when controlling for oral candidiasis, CD4 + cell count, and sites (95% confidence interval 1.04–1.65, P = 0.02). Conclusion: Oral CMV shedding was significantly higher in highly immunocompromised HIV + participants. Our finding supports the recommendations to start antiretroviral therapy independent of CD4 + cell count as this may have the added benefit to lower the risk of herpesvirus transmission among persons infected with HIV and their partners.