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Herpesvirus infection of eye and brain in HIV infected patients
  1. Robert F Miller1,
  2. Mark R Howard2,
  3. Peggy Frith3,
  4. Christopher J Perrons2,
  5. Irene Pecorella5,
  6. Sebastian B Lucas4
  1. 1Department of Sexually Transmitted Diseases, Windeyer Institute of Medical Sciences, Royal Free and University College Medical School and Camden and Islington Community Health Services Trust, Mortimer Market Centre, London WC1E 6AU
  2. 2Department of Virology, Windeyer Institute of Medical Sciences, Royal Free and University College Medical School, London W1P 6OB
  3. 3The Eye Department, University College London Hospitals, London W1N 8AA
  4. 4Department of Histopathology, Guy's, Kings and St Thomas's School of Medicine, St Thomas's Hospital, London SE1 7EH
  5. 5Dipartimento di Medicina Sperimentale e Patologia, Universita degli Studi, “La Sapienza” 00161 Rome, Italy
  1. Dr R F Miller, Department of Sexually Transmitted Diseases, Windeyer Institute of Medical Sciences, Royal Free and University College Medical School, Mortimer Market Centre, London WC1E 6AU rmiller{at}gum.ucl.ac.uk

Abstract

Objectives: To compare histological with genome detection methods for diagnosis of herpesvirus infection in eye and brain of HIV infected patients undergoing necropsy and to correlate these findings with both antemortem clinical findings and postmortem evidence of extraocular herpesvirus infection, especially in the CNS.

Methods: A prospective study of 31 consecutive HIV infected patients undergoing necropsy. In life 11 patients had been assessed by an ophthalmologist because of ocular symptoms. Ocular and brain samples were examined for herpesviruses by conventional histological methods and by nested polymerase chain reaction (nPCR) for all eight human herpesviruses; evidence of extraneural herpesvirus infection was sought by histological methods.

Results: Although only 12 out of 31 patients (39%) had antemortem clinical evidence of ocular or CNS herpesvirus associated disease, herpesviruses were detected by nPCR in eye and brain from 26 (84%) patients; six patients had more than one herpesvirus infection. There was concordance between ocular and CNS findings in 15 of 19 patients (79%) with CMV infection. 17 of 31 patients (55%) had extraocular or CNS CMV infection at necropsy. Genome detection using nPCR was superior to histological methods for diagnosis of ocular and CNS herpesvirus infection.

Conclusion: Herpesvirus infection of eye and brain was a frequent finding at necropsy in this group of HIV infected patients; almost a fifth were co-infected by more than one herpesvirus. This was more than twice the incidence predicted from clinical evidence before death. Genome detection using nPCR was superior to histological methods for diagnosis of ocular and CNS herpesvirus infection.

  • AIDS
  • necropsy
  • herpesviruses
  • DNA detection
  • CMV retinitis
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