Skip to main content
NCBI home page
Sexually Transmitted Infections logoLink to Sexually Transmitted Infections
. 2000 Aug;76(4):282–286. doi: 10.1136/sti.76.4.282

Herpesvirus infection of eye and brain in HIV infected patients

R Miller 1, M Howard 1, P Frith 1, C Perrons 1, I Pecorella 1, S Lucas 1
PMCID: PMC1744183  PMID: 11026884

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.

Key Words: AIDS; necropsy; herpesviruses; DNA detection; CMV retinitis

Full Text

The Full Text of this article is available as a PDF (113.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aurelius E., Johansson B., Sköldenberg B., Forsgren M. Encephalitis in immunocompetent patients due to herpes simplex virus type 1 or 2 as determined by type-specific polymerase chain reaction and antibody assays of cerebrospinal fluid. J Med Virol. 1993 Mar;39(3):179–186. doi: 10.1002/jmv.1890390302. [DOI] [PubMed] [Google Scholar]
  2. Batisse D., Eliaszewicz M., Zazoun L., Baudrimont M., Pialoux G., Dupont B. Acute retinal necrosis in the course of AIDS: study of 26 cases. AIDS. 1996 Jan;10(1):55–60. doi: 10.1097/00002030-199601000-00008. [DOI] [PubMed] [Google Scholar]
  3. Brink N. S., Fox J. D., Waite J. C., Sharvell Y., Miller R. F. Detection of varicella-zoster virus DNA by nested PCR in CSF from HIV-infected patients: A prospective evaluation. J NeuroAIDS. 1998;2(1):99–105. doi: 10.1300/J128v02n01_07. [DOI] [PubMed] [Google Scholar]
  4. Brink N. S., Sharvell Y., Howard M. R., Fox J. D., Harrison M. J., Miller R. F. Detection of Epstein-Barr virus and Kaposi's sarcoma-associated herpesvirus DNA in CSF from persons infected with HIV who had neurological disease. J Neurol Neurosurg Psychiatry. 1998 Aug;65(2):191–195. doi: 10.1136/jnnp.65.2.191. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Burke D. G., Kalayjian R. C., Vann V. R., Madreperla S. A., Shick H. E., Leonard D. G. Polymerase chain reaction detection and clinical significance of varicella-zoster virus in cerebrospinal fluid from human immunodeficiency virus-infected patients. J Infect Dis. 1997 Oct;176(4):1080–1084. doi: 10.1086/516516. [DOI] [PubMed] [Google Scholar]
  6. Chang M., van der Horst C. M., Olney M. S., Peiffer R. L. Clinicopathologic correlation of ocular and neurologic findings in AIDS: case report. Ann Ophthalmol. 1986 Mar;18(3):105-6, 110-1. [PubMed] [Google Scholar]
  7. Cinque P., Bossolasco S., Vago L., Fornara C., Lipari S., Racca S., Lazzarin A., Linde A. Varicella-zoster virus (VZV) DNA in cerebrospinal fluid of patients infected with human immunodeficiency virus: VZV disease of the central nervous system or subclinical reactivation of VZV infection? Clin Infect Dis. 1997 Sep;25(3):634–639. doi: 10.1086/513754. [DOI] [PubMed] [Google Scholar]
  8. Cinque P., Vago L., Dahl H., Brytting M., Terreni M. R., Fornara C., Racca S., Castagna A., Monforte A. D., Wahren B. Polymerase chain reaction on cerebrospinal fluid for diagnosis of virus-associated opportunistic diseases of the central nervous system in HIV-infected patients. AIDS. 1996 Aug;10(9):951–958. doi: 10.1097/00002030-199610090-00004. [DOI] [PubMed] [Google Scholar]
  9. Corboy J. R., Garl P. J., Kleinschmidt-DeMasters B. K. Human herpesvirus 8 DNA in CNS lymphomas from patients with and without AIDS. Neurology. 1998 Feb;50(2):335–340. doi: 10.1212/wnl.50.2.335. [DOI] [PubMed] [Google Scholar]
  10. Fox J. D., Brink N. S., Zuckerman M. A., Neild P., Gazzard B. G., Tedder R. S., Miller R. F. Detection of herpesvirus DNA by nested polymerase chain reaction in cerebrospinal fluid of human immunodeficiency virus-infected persons with neurologic disease: a prospective evaluation. J Infect Dis. 1995 Oct;172(4):1087–1090. doi: 10.1093/infdis/172.4.1087. [DOI] [PubMed] [Google Scholar]
  11. Holland G. N., Pepose J. S., Pettit T. H., Gottlieb M. S., Yee R. D., Foos R. Y. Acquired immune deficiency syndrome. Ocular manifestations. Ophthalmology. 1983 Aug;90(8):859–873. doi: 10.1016/s0161-6420(83)80009-8. [DOI] [PubMed] [Google Scholar]
  12. Holland N. R., Power C., Mathews V. P., Glass J. D., Forman M., McArthur J. C. Cytomegalovirus encephalitis in acquired immunodeficiency syndrome (AIDS). Neurology. 1994 Mar;44(3 Pt 1):507–514. doi: 10.1212/wnl.44.3_part_1.507. [DOI] [PubMed] [Google Scholar]
  13. Jensen O. A., Klinken L. Pathology of brain and eye in the acquired immune deficiency syndrome (AIDS). A comparison of lesions in a consecutive autopsy material. APMIS. 1989 Apr;97(4):325–333. doi: 10.1111/j.1699-0463.1989.tb00795.x. [DOI] [PubMed] [Google Scholar]
  14. Kidd I. M., Clark D. A., Ait-Khaled M., Griffiths P. D., Emery V. C. Measurement of human herpesvirus 7 load in peripheral blood and saliva of healthy subjects by quantitative polymerase chain reaction. J Infect Dis. 1996 Aug;174(2):396–401. doi: 10.1093/infdis/174.2.396. [DOI] [PubMed] [Google Scholar]
  15. Lucas S. B., Hounnou A., Peacock C., Beaumel A., Djomand G., N'Gbichi J. M., Yeboue K., Hondé M., Diomande M., Giordano C. The mortality and pathology of HIV infection in a west African city. AIDS. 1993 Dec;7(12):1569–1579. doi: 10.1097/00002030-199312000-00005. [DOI] [PubMed] [Google Scholar]
  16. Meenken C., van den Horn G. J., Danner S. A. Ocular and neurological complications of varicella zoster virus infection in a patient with AIDS. AIDS. 1996 Sep;10(10):1174–1175. [PubMed] [Google Scholar]
  17. Miller R. F., Brink N. S., Cartledge J., Sharvell Y., Frith P. Necrotising herpetic retinopathy in patients with advance HIV disease. Genitourin Med. 1997 Dec;73(6):462–466. doi: 10.1136/sti.73.6.462. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Miller R. F., Hall-Craggs M. A., Costa D. C., Brink N. S., Scaravilli F., Lucas S. B., Wilkinson I. D., Ell P. J., Kendall B. E., Harrison M. J. Magnetic resonance imaging, thallium-201 SPET scanning, and laboratory analyses for discrimination of cerebral lymphoma and toxoplasmosis in AIDS. Sex Transm Infect. 1998 Aug;74(4):258–264. doi: 10.1136/sti.74.4.258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Miller R. F., Lucas S. B., Hall-Craggs M. A., Brink N. S., Scaravilli F., Chinn R. J., Kendall B. E., Williams I. G., Harrison M. J. Comparison of magnetic resonance imaging with neuropathological findings in the diagnosis of HIV and CMV associated CNS disease in AIDS. J Neurol Neurosurg Psychiatry. 1997 Apr;62(4):346–351. doi: 10.1136/jnnp.62.4.346. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Mitchell S. M., Fox J. D., Tedder R. S., Gazzard B. G., Lightman S. Vitreous fluid sampling and viral genome detection for the diagnosis of viral retinitis in patients with AIDS. J Med Virol. 1994 Aug;43(4):336–340. doi: 10.1002/jmv.1890430404. [DOI] [PubMed] [Google Scholar]
  21. Morinelli E. N., Dugel P. U., Riffenburgh R., Rao N. A. Infectious multifocal choroiditis in patients with acquired immune deficiency syndrome. Ophthalmology. 1993 Jul;100(7):1014–1021. doi: 10.1016/s0161-6420(93)31543-5. [DOI] [PubMed] [Google Scholar]
  22. Pepose J. S., Hilborne L. H., Cancilla P. A., Foos R. Y. Concurrent herpes simplex and cytomegalovirus retinitis and encephalitis in the acquired immune deficiency syndrome (AIDS). Ophthalmology. 1984 Dec;91(12):1669–1677. doi: 10.1016/s0161-6420(84)34108-2. [DOI] [PubMed] [Google Scholar]
  23. Pillay D., Lipman M. C., Lee C. A., Johnson M. A., Griffiths P. D., McLaughlin J. E. A clinico-pathological audit of opportunistic viral infections in HIV-infected patients. AIDS. 1993 Jul;7(7):969–974. doi: 10.1097/00002030-199307000-00010. [DOI] [PubMed] [Google Scholar]
  24. Qavi H. B., Green M. T., SeGall G. K., Lewis D. E., Hollinger F. B. Transcriptional activity of HIV-1 and HHV-6 in retinal lesions from AIDS patients. Invest Ophthalmol Vis Sci. 1992 Sep;33(10):2759–2767. [PubMed] [Google Scholar]
  25. Said J. W., Tasaka T., de Vos S., Koeffler H. P. Kaposi's sarcoma-associated herpesvirus/human herpesvirus type 8 encephalitis in HIV-positive and -negative individuals. AIDS. 1997 Jul 15;11(9):1119–1122. doi: 10.1097/00002030-199709000-00006. [DOI] [PubMed] [Google Scholar]
  26. Seregard S. Retinochoroiditis in the acquired immune deficiency syndrome. Findings in consecutive post-mortem examinations. Acta Ophthalmol (Copenh) 1994 Apr;72(2):223–228. doi: 10.1111/j.1755-3768.1994.tb05020.x. [DOI] [PubMed] [Google Scholar]
  27. Whitby D., Howard M. R., Tenant-Flowers M., Brink N. S., Copas A., Boshoff C., Hatzioannou T., Suggett F. E., Aldam D. M., Denton A. S. Detection of Kaposi sarcoma associated herpesvirus in peripheral blood of HIV-infected individuals and progression to Kaposi's sarcoma. Lancet. 1995 Sep 23;346(8978):799–802. doi: 10.1016/s0140-6736(95)91619-9. [DOI] [PubMed] [Google Scholar]

Articles from Sexually Transmitted Infections are provided here courtesy of BMJ Publishing Group

RESOURCES