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

TitleOral shedding of herpesviruses in HIV-infected patients with varying degrees of immune status.
Publication TypeJournal Article
Year of Publication2017
AuthorsDittmer DP, Tamburro K, Chen H, Lee A, Sanders MK, Wade TA, Napravnik S, Webster-Cyriaque J, Ghannoum M, Shiboski CH, Aberg JA
JournalAIDS
Volume31
Issue15
Pagination2077-2084
Date Published2017 Sep 24
ISSN1473-5571
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.

DOI10.1097/QAD.0000000000001589
Alternate JournalAIDS
PubMed ID28723706
PubMed Central IDPMC5599345
Grant ListR01 DE018304 / DE / NIDCR NIH HHS / United States
UM1 AI068634 / AI / NIAID NIH HHS / United States
U01 AI068636 / AI / NIAID NIH HHS / United States
R01 DE023946 / DE / NIDCR NIH HHS / United States
U01 AI068634 / AI / NIAID NIH HHS / United States
UM1 AI068636 / AI / NIAID NIH HHS / United States