Oral shedding of herpesviruses in HIV-infected patients with varying degrees of immune status

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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.

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