Relationship between herpes simplex virus ulceration and CD4+ cell counts in patients with HIV infection.
OBJECTIVE
To establish the incidence of herpes simplex virus (HSV) ulceration in relation to CD4+ cell counts in HIV-infected patients.


METHODS
Swabs were taken from all ulcerated lesions in HIV-infected patients and cultured for HSV. CD4+ cell counts were performed at regular intervals.


METHODS
The HIV unit at a London teaching hospital (the Royal Free Hospital, London, UK).


METHODS
All HIV-infected patients (n = 500) attending the HIV unit.


RESULTS
Two hundred and twenty-three swabs were obtained from 118 patients; 83 (37.2%) swabs from 62 (52.5%) patients were positive for HSV. Of 96 swabs taken from patients with CD4+ cell counts < 50 x 10(6)/l, 56 (58.3%) were positive for HSV, compared with 27 of 127 (21.2%) swabs from patients with higher CD4+ cell counts (P < 0.0001). Of patients with CD4+ cell counts < 50 x 10(6)/l, 37 of 47 (78.7%) had positive cultures compared with 25 of 71 (35.2%) of patients with higher counts (P < 0.0001). This trend was observed with swabs from all body sites; sufficient samples were available from oral and perianal lesions to demonstrate statistical significance (P < 0.0001 and P = 0.007, respectively).


CONCLUSIONS
These results show a sharp rise in the incidence of HSV with CD4+ cell counts < 50 x 10(6)/l and thus provide important data for the design of studies of anti-HSV prophylaxis. Furthermore, since nearly 60% of all ulcers in patients with such low CD4+ counts are HSV-positive, we suggest appropriate empirical therapy on presentation.
Department of Thoracic Medicine, Royal Free Hospital and School of Medicine, London, UK.
E K
EK
Bagdades
D
D
Pillay
S B
SB
Squire
C
C
O'Neil
M A
MA
Johnson
P D
PD
Griffiths
D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000150:complications* / Q000276:immunology; D015496:CD4-Positive T-Lymphocytes; D006561:Herpes Simplex / Q000097:blood / Q000150:complications* / Q000276:immunology; D006801:Humans; D007958:Leukocyte Count; D018139:Simplexvirus / Q000302:isolation & purification; D014456:Ulcer / Q000382:microbiology