Low prevalence of varicella zoster virus and herpes simplex virus type 2 in saliva from human immunodeficiency virus-infected persons in the era of highly active antiretroviral therapy.

OBJECTIVES: Human herpesviruses, e.g., herpes simplex virus (HSV) type 1, Epstein-Barr virus, and cytomegalovirus, appear in saliva at greater frequency in persons infected with human immunodeficiency virus (HIV) than in healthy individuals. However, it is not known if varicella zoster virus (VZV) and HSV-2 appear simultaneously during HIV infection at greater frequency in saliva in this era of highly active antiretroviral therapy (HAART). The aim of this study was to investigate the prevalence and amounts of VZV and HSV-2 in the saliva of HIV-infected orally asymptomatic patients. STUDY DESIGN: Quantitative polymerase chain reaction was used to investigate the prevalence, quantity, risk, and correlations of salivary VZV and HSV-2 from 59 HIV-seropositive individuals and 53 healthy control subjects in a case-control cross-sectional study. Seventy-eight percent of the HIV-seropositive patients (46 out of 59) were taking HAART. RESULTS: VZV DNA was detected in the saliva of 5.1% (3 out of 59) of the HIV-positive group and in only 1 healthy control 1.9% (1 out of 53; P = .62). The amount of VZV DNA in the expressors was low, generally <1,100 copies/mL, with no observed difference between the HIV-positive group and the control subjects (P = 1.0). HSV-2 DNA was not detected in either group. In the HIV-infected group, VZV shedding occurred in those on HAART, but was not associated with oral lesions, specific CD4(+) or CD8(+) T-cell levels, or demographic factors. CONCLUSIONS: Varicella zoster virus was detected at low prevalence in the saliva of HIV-infected persons, whereas HSV-2 was not detected in the saliva of this cohort. HAART does not appear to diminish the risk for asymptomatic VZV shedding.

The HIV Dementia Scale: predictive power in mild dementia and HAART.

BACKGROUND: HIV-associated dementia (HIV-D) is a subcortical dementia consisting of cognitive and motor symptoms that ultimately affects as many as 20% of patients with AIDS and is associated with significant morbidity and mortality. With the advent of highly active antiretroviral therapy (HAART), the use of sensitive and efficient screening tests for HIV-D continue to be needed for identifying individuals who develop this disorder. OBJECTIVE: The objective of this study was to compare the HIV Dementia Scale (HDS) with comprehensive neuropsychological procedures in detecting both minor cognitive and motor disorder (MCMD) and HIV-D in a population of patients with varying durations of HAART. METHODS: Forty-six HIV-seropositive patients completed both the HDS and a battery of neuropsychological tests as they enrolled in a MRI study. Each person was also assigned a MSK score based on clinical neurological examination. HDS score of 10 were considered cognitively unimpaired. Two separate sensitivity analyses were performed. Global Z scores (NPZ8) averaged from eight individual neuropsychological subtests were compared to the HDS score for each subject. An NPZ8 score -2.0 standard deviations (S.D.) below the mean was used to define HIV-D. Additionally, HIV-D, defined as -2.0 S.D. below the mean on one test or -1.0 S.D. below the mean on two or more tests from the NPZ8, were also compared to the HDS. Finally, performance on these cognitive measures was used to predict duration of HAART in this sample. RESULTS: Using the average NPZ8 score based on American Academy of Neurology consensus criteria yielded a test sensitivity of 30%, a specificity of 0%, a positive predictive value of 0%, and a negative predictive value of 58% when compared to clinical MSK ratings. Comparison of the number of impaired tests with MSK severity yielded a test sensitivity of 43%, a specificity of 91%, a positive predictive value of 83%, and a negative predictive value of 61%. HDS scores were less efficient in predicting the presence of subtle and mild HIV-D in this sample. CONCLUSION: While the HDS is a useful bedside test that a physician may quickly administer to HIV seropositive patients to assist in diagnosing suspected cases of frank HIV-D, the HDS, as a screen, is not as accurate in detecting HIV-D as a more thorough neuropsychological examination. With an increasing prevalence of HIV-D and minor cognitive/motor disorder (MCMD) following the introduction of HAART, the development of more sensitive bedside measures is essential in order to identify individuals with these disorders and monitor treatment regimens.

High prevalence of multiple human herpesviruses in saliva from human immunodeficiency virus-infected persons in the era of highly active antiretroviral therapy.

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 HIV-seropositive 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

JC virus detection in bodily fluids: clues to transmission.

JC virus in saliva, oropharyngeal fluid, blood, and urine samples obtained from 58 human immunodeficiency virus-infected persons and 58 matched controls was investigated by performing quantitative polymerase chain reaction. JC virus was rarely present in oropharyngeal fluid and blood samples, even in those obtained from immunosuppressed individuals, but it was commonly detected in urine samples from both groups, suggesting that urine contributes to transmission.

Cerebrospinal fluid proteomics and human immunodeficiency virus dementia: preliminary observations.

Protein profiling using mass spectrometry may be useful in identifying previously unknown protein markers in human immunodeficiency virus (HIV) dementia and provide insight into disease pathogenesis. Six samples of matched cerebrospinal (CSF) and blood serum from patients with no, mild, and moderate dementia were prepped for biomarker screening by the Ciphergen system. Chips were analyzed in the matrix-assisted laser desorption/ionization (MALDI) mass spectrometer at low mass (700 to 20,000 Da) and at higher mass (5000 to 100,000 Da). In both serum and CSF samples, differences in protein intensity appeared to correlate with degree of dementia. This preliminary study suggests that protein markers of HIV dementia may be detected by MALDI mass spectrometry.