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December 1998

Volume 178, Number 6
The Journal of Infectious Diseases 1998;178:1616–1622
© 1998 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/98/7806-0011$02.00
DOI: 10.1086/314486

Frequency of Symptomatic and Asymptomatic Herpes Simplex Virus Type 2 Reactivations among Human Immunodeficiency Virus–Infected Men

Timothy Schacker,

Judith Zeh,

Hui‐lin Hu,

Edgar Hill, and

Lawrence Corey

Department of Medicine, University of Minnesota, Minneapolis; Departments of Medicine, Laboratory Medicine, Statistics, and Microbiology, University of Washington, and Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, Washington; Glaxo Wellcome, Chapel Hill, North Carolina

Abstract

Herpes simplex virus (HSV) infection is common in persons coinfected with human immunodeficiency virus (HIV). In a prospective study, daily viral cultures of the mouth, genitals, and rectum were collected from 68 HIV‐positive and 13 HIV‐negative men who have sex with men. Subjects completed a median of 57 days of follow‐up. Anogenital HSV‐2 cultures were positive on 405 (9.7%) of 4167 days for HIV‐positive men and on 24 (3.1%) of 766 days for HIV‐negative men. Most reactivations were perirectal and subclinical. Risk factors for increased HSV‐2 shedding among HIV‐positive men were low CD4 cell count (odds ratio, 2.5; 95% confidence interval, 1.2–5.4) and antibodies to both HSV‐1 and HSV‐2 versus HSV‐2 only (odds ratio, 1.9; 95% confidence interval, 1.0–3.7). Three isolates obtained from 3 separate subjects were resistant to acyclovir. Thus, subclinical HSV‐2 reactivation is an important opportunistic infection in persons with HIV infection. Further studies are necessaryto determine the impact of subclinical HSV‐2 reactivation on the natural history of HIV infection.

Received 12 January 1998; revised 4 June 1998.

Correspondence: Dr. Timothy Schacker, University of Minnesota, Dept. of Medicine, Box 250, 516 Delaware St. SE, Minneapolis, MN 55455 ().

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  • The study protocol was approved by the University of Washington Institutional Review Board.

    Financial support: NIH (AI‐30731, AI 01338; AIDS Clinical Trials Group grant AI‐27664).

    Reprints: Dr. Larry Corey, Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, 1124 Columbia St., M‐115, Seattle, WA 98104.

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