High Prevalence of Multiple Human Herpesviruses in Saliva from Human Immunodeficiency Virus-Infected Persons in the Era of Highly Active Antiretroviral Therapy

Abstract

Human immunodeficiency virus (HIV) infection is associated with an increased risk for human herpesviruses (HHVs) and their related diseases. Methods for limiting the transmission of HHVs require a better understanding of the prevalence and infectiousness of oral HHVs in HIV-infected patients. We performed quantitative PCR to investigate the prevalence, quantity, risk, and correlates of salivary HHVs from 58 HIVseropositive individuals in a case control study. HHVs were significantly more prevalent in the salivas of HIV-seropositive persons than in those of the controls (odds ratios [ORs], 4.2 to 26.2; P < 0.008). In HIV-infected patients, Epstein-Barr virus (EBV), human herpesvirus 8 (HHV-8), cytomegalovirus (CMV), and herpes simplex virus type 1 (HSV-1) were detected in 90%, 57%, 31% and 16% of samples, respectively, compared with 48%, 24%, 2%, and 2%, respectively, of samples from controls. Multiple HHVs were observed in 71% of HIV-seropositive persons and only 16% of controls (OR, 13.0; 95% confidence interval, 5.29 to 32.56). HIV-positive patients had significantly higher EBV loads than HIV-negative persons (P < 0.0001). HIVinfected patients with CD4 counts above 200 cells/l had increased probability for having HHV-8 in saliva (P ‫؍‬ 0.009) compared with patients whose counts were less than 200. In contrast, HSV-1, EBV, and CMV were detected more often when CD4 counts were low. High salivary HHV loads were detected for those (n ‫؍‬ 7) with oral lesions. These findings suggest that saliva is a potential risk factor for the acquisition of multiple HHVs, and several host factors may function to accelerate HHV reactivation or replication in patients with HIV infection.

PCR detection of multiple human herpesvirus DNA in saliva from HIV-infected individuals in Teresina, State of Piauí, Brazil

“…However, the statistical analysis only showed a risk for CMV and EBV shedding in the saliva of HIV-seropositive patients. These data are consistent with other studies that showed high CMV and EBV salivary shedding among more immunosuppressed patients in comparison with HIV-seronegative individuals 4,7,10 . Even in patients submitted to HAART, EBV and CMV shedding appears to persist at a higher frequency compared with HIV-uninfected controls 8,12 .…”

“…The frequencies of these viruses are wide-ranging, varying from 62 to 90% for EBV; 57% for HHV-8; 19 to 72% for CMV and 5 to 16 for HSV-1 4,7,[10][11][12] . In these reports, the prevalence of HHVs was higher in HIV-seropositive patients than seronegative individuals.…”

“…Besides the high frequencies of HHVs in saliva from HIV-infected patients, none of these patients presented oral lesions due to HHV activity. This could be explained by the fact that HHVs are frequently shed asymptomatically in the saliva of HIV-infected patients under HAART 4,8,31,32 .…”

“…Additionally, EBV and HHV-8 are also implicated in systemic diseases 2 . The transmission of these viruses occurs by contact with infected secretions, especially saliva [3][4][5][6] . The majority of HHV infected individuals show no clinical symptoms, but can shed HHVs asymptomatically in saliva 4,7,8 .…”

Detection of a Second Novel Gammaherpesvirus in a Free-ranging Koala (Phascolarctos cinereus)

“…Bootstrapping values (n5100) are shown for this koala suggests that both were active infections. In humans, multiple active herpesvirus infections are most often associated with severe immunosuppression (Miller et al, 2006). It is possible that this koala was experiencing primary or recrudescent infection with these herpesviruses as a consequence of immunosuppression due to chronic stress or disease of another etiology.…”