Influence of Human Immunodeficiency Virus Status on the Clinical History of Herpes simplex Keratitis

Abstract

Human immunodeficiency virus (HIV) infection is associated with a wide spectrum of systemic and ocular infectious diseases. Little is known about its association with herpes simplex keratitis (HSK) in this geographical region (South India). A retrospective study was undertaken to analyze this association in a cohort of 30 virologically proven recurrent HSK cases. Laboratory methods included herpes simplex virus (HSV) isolation, HSV antigen detection and tear secretory IgA or HSV DNA detection while commercial ELISA kits detected HIV infection. The rationale behind the HIV screening was to assess the role of HIV with increased HSK recurrences. Confirmed HIV seropositivity was 16.7% in recurrent HSK cases as against 3.3% in the matched first-episode HSK cases (p < 0.05, Fisher’s exact test). Our observations on the features of herpetic keratitis in HIV-proven patients, though based on a small number of cases, raise the question whether the immunological abnormalities associated with HIV/AIDS may affect the clinical course of HSK.

Herpetic ocular manifestations in a patient with GATA2 deficiency

“…Stromal disease appears, at least in part, to be an immunological lymphocyte response to HSV antigens in the cornea. It is thus conceivable that the lymphocyte dysfunction associated with immunosuppression by immunodeficiencies might have actually protected this patient against developing stromal keratitis 7 …”

Herpes simplex keratitis-induced endophthalmitis in a patient with AIDS with disseminated tuberculosis

“…HSV keratitis is usually followed by symptoms such as corneal scarring, iritis and raised IOP. Corneal involvement has been reported infrequently in individuals with AIDS or other immunosuppressed status 16 18. Holland et al classified HSV keratitis into four categories: (1) infectious epithelial keratitis which is made up of cornea vesicles, dendritic ulcer, geographic ulcer and marginal ulcer, (2) neurotrophic keratopathy, (3) stromal keratitis and (4) endotheliitis.…”

Molecular methods in the diagnosis of HSV stromal keratitis

“…Диагностичната полза от PCR детекцията на HSV ДНК в слъзни проби при стромални и дисциформени лезии се подчертава и от други автори, особено когато роговична биопсия не е желателна и конвенционалните техники за директно доказване на HSV като изолация на вирус и антигенно откриване сa трудни (9). Ние установяваме генетичен материал от херпес симплекс вирус в 28,6% при типични и до 50% при атипични форми на стромално засягане.…”