Detection of herpes simplex virus DNA in plasma of patients with primary but not with recurrent infection: implications for transfusion medicine?

Among the family of herpes viruses, only cytomegalovirus (CMV) and, to a lesser extent, human herpes virus 8 (HHV-8) are of relevance in transfusion medicine. Due to neutropism, herpes simplex viruses (HSV) types 1 and 2 are considered to be of minor relevance. However, several reports gave evidence that a HSV DNAemia might occur and HSV could therefore be transmissible by blood products. The aim of our study was to collect data about prevalence of HSV antibodies among blood donors and to clarify whether HSV DNAemia is possible. HSV antibody states of 653 blood donors were investigated. Blood specimens of 46 patients with primary and recurrent HSV infection were tested for HSV-1 and HSV-2 DNA using TaqMan polymerase chain reaction. In 505 of the 653 blood donors HSV antibodies were detectable, most of which were HSV-1 antibodies. HSV DNA was detected in plasma, but not in peripheral blood mononuclear cells (PBMCs) of seven rather seriously ill patients with primary herpes genitalis. No HSV viraemia was detectable in otherwise healthy patients with recurrent herpes labialis. Thus, HSV DNAemia is possible, but seems to be limited to primary infections and could not be detected in the recurrent infection. Therefore, blood donors with primary herpes infection should be deferred from donation. Blood donors with recurrent HSV infection are probably not at risk of transmitting HSV, but further studies are necessary to prove this hypothesis. Detection of HSV DNA in PBMCs as described formerly could not be confirmed by this study.

Oncogenic human papillomavirus DNA loads in human immunodeficiency virus-positive women with high-grade cervical lesions are strongly elevated.

Human papillomavirus (HPV) DNA loads of six oncogenic HPV types were measured by real-time PCR in cervical scrapes of human immunodeficiency virus (HIV)-infected and uninfected women. In both groups, HPV loads increased with the grade of cervical disease. HIV infection did not affect HPV loads in low-grade lesions but was associated with significantly higher HPV loads in severe dysplasia; highest loads were found in advanced HIV disease. Our data reflect the aggressive course of HPV infection in HIV-positive women.

[Efficiency and side effects of antiretroviral treatment of HIV infected pregnant women]. / Effektivität und Nebenwirkungen der antiretroviralen Therapie bei HIV infizierten Schwangeren.

OBJECTIVE: Antiretroviral treatment (ART) of pregnant women and newborn reduces the vertical HIV transmission below 2 % but long term effects are still not clear. METHOD: We analyzed the data of 59 children born to HIV infected women. RESULTS: The median observation time was 404 (14-740) days. There was no vertical HIV transmission (95 %-confidence interval [CI] 0-5.1 %). Among 6 children without prenatal ART one child with congenital diaphragmatic hernia was born. In 53 infants with prenatal ART we observed 19 congenital malformations (35.8 %, 95 %-CI 23.2-50.6 %). Three were severe malformations (5.7 %, 95 %-CI 1.2-15.5 %): one supraorbital hemangioma (after zidovudine), one athetoid cerebral palsy without evidence of mitochondrial dysfunction (after zidovudine), and one unilateral femoral hypoplasia (after short term zidovudine, lamivudine, and efavirenz in late pregnancy). Sixteen minor malformations were found (30.1 %, 95 %-CI 21.2-43.8 %): ventricular septal defect (closed spontaneously after 6 months), atrial septal defect, transient and persistent pulmonary stenoses, hexadactylies, unilateral hearing impairment, dystopic kidney, subependymal bleeding cysts, and mild dilation of ventricles. CONCLUSIONS: ART prevents vertical HIV transmission. All women should be advised ART during pregnancy and delivery. The prevalence of malformations after prenatal/perinatal ART appears considerably high. Therefore, detailed information for the parents and long term follow-up of all children exposed to antiretroviral drugs are crucial.

[Women and AIDS. HIV-positive patients need special monitoring]. / Frauen und AIDS. HIV-positive Patientinnen brauchen eine besondere Betreuung.

Worldwide, 50% of all HIV-positive persons are female. The situation is particularly dismal in Africa and Asia, in South America and in the Caribbean. Germany is confronted with a high percentage of immigrants from countries in these parts of the world, and consequently must expect to see an increasing rate of HIV-positive women from these regions. This makes programs for the management of female HIV-positive victims an urgent necessity. The present article describes a multidisciplinary concept, whose aim it is, via comprehensive preventive measures, to avoid medium- and long-term complications.

[Potential of selenium in gynecologic oncology]. / Potential des Selens in der gynäkologischen Onkologie.

BACKGROUND: Studies on potential benefits of selenite in cancers of the female genital tract and breast cancer have concentrated on 2 fields: prevention on one side, complementary oncological therapy on the other side. Big studies have been realized in the past which have shown no clear effect of selenium supplementation in prevention of female cancers and breast cancer in the industrialized nations of Europe and Northern America. Few investigations exist on the therapeutic effects of selenium therapy in the clinical field of gyneco-oncology. EXPERIENCES: Many patients with malignant disease of the female breast and genital tract are strongly demanding additional therapeutical concepts in natural medicine in addition to adjuvant or palliative chemo- or hormonal therapy and supportive medication. In pilot studies with low-dose natrium selenite (up to 300 micrograms/day) they report a better quality of life. Side effects were not reported. Analysis of the immune system reveal a stimulation of B19 lymphocytes and natural killer cells. CONCLUSION: In Germany, a country with selenium deficiency, clinical studies are now carried out on the effects of selenium as a drug to reduce side effects of chemo- and radiotherapy, enhance quality of life by reducing toxic side effects and help to restore immune function.

[Current position on the care of HIV-seropositive pregnancies]. / Aktueller Stand der Betreuung der HIV-positiven Schwangerschaft.

The reduction of vertical transmission rates in Germany to 5-7% is basically due to antiretroviral therapy during pregnancy with zidovudine and elective caesarean section after 37 weeks of gestation. Maternal versus fetal needs have to be considered carefully in respect to mode of delivery and antiretroviral therapy. Long term consequences for the fetus of antiretroviral therapy are not yet sufficiently known.