title: Subclinical reactivation of varicella zoster virus in all stages of HIV infection.
abstract: Analysis of 200 paired serum and cerebrospinal fluid (CSF) samples from 180 HIV-positive individuals, 136 of whom had AIDS, revealed intrathecal synthesis of antibodies specific for varicella zoster virus (VZV) in 28 (16%) individuals, measles virus in 15 (8%), herpes simplex virus-1 (HSV-1) in 1 (0.6%), and HSV-2 in none. Of the 28 subjects with a positive VZV antibody specificity index, only 1 had zoster rash at the time of serum and CSF sampling; of the total 180 HIV-positive subjects, 146 (81%) had no history of zoster. Based on an estimated 33.4 million HIV-positive individuals worldwide, subclinical reactivation of VZV in even less than 16% of HIV-positive people suggests the possibility that millions of people have active VZV infection of the central nervous system. In cases of VZV vasculopathy, myelopathy and even zoster sine herpete, the CSF is often positive for anti-VZV antibody, but negative for VZV DNA. To rule out VZV infection of the nervous system, CSF must be tested for VZV DNA and anti-VZV IgG and IgM antibody.
authors.affiliation: Department of Neurology, University of Colorado School of Medicine, Aurora, CO 80045, USA.
authors.forename: Marius
authors.initials: M
authors.lastname: Birlea
authors.forename: Gabriele
authors.initials: G
authors.lastname: Arendt
authors.forename: Eser
authors.initials: E
authors.lastname: Orhan
authors.forename: D Scott
authors.initials: DS
authors.lastname: Schmid
authors.forename: William J
authors.initials: WJ
authors.lastname: Bellini
authors.forename: Christian
authors.initials: C
authors.lastname: Schmidt
authors.forename: Don
authors.initials: D
authors.lastname: Gilden
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Cohrs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood / Q000134:cerebrospinal fluid; D058345:Asymptomatic Infections; D020804:Encephalitis, Varicella Zoster / Q000097:blood / Q000134:cerebrospinal fluid; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000302:isolation & purification / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014775:Virus Activation / Q000502:physiology*; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral