Comparison of oral manifestations with CD4 count in HIV-infected patients.

Aim and Objective: This study was carried out with the primary aim of correlating oral changes and general changes of HIV-infected patients with their CD4 count. Materials and Methods: 124 patients were selected, and after taking their informed consent, they were subjected to detailed history taking and thorough clinical examination. Specific oral lesions and general physical changes were recorded. Every patient was subjected to laboratory investigation for CD4 count. All these findings were tabulated. The clinical observation and laboratory findings were subjected to critical analysis and correlated. Statistical test, i.e. Student's " t" test, was applied and objective conclusions were drawn. Result: Out of 124 patients, 40 had oral candidiasis, 6 had oral hairy leukoplakia, 12 had periodontal disease, 20 had xerostomia, 30 had melanin pigmentation, while 4 had HSV2, and atypical ulceration. Out of 40 patients with oral candidiasis, 28 patients had CD4 count <200 (group A), 10 patients were in group, B (CD4 count 200-500 cell/mm 3 ) and 2 patients in group C(CD4 >500 cell/mm 3 ). Oral hairy leukoplakia occurred in equal proportions in group A and B. These periodontal diseases were more commonly in group B; xerostomia and melanin pigmentation was equally seen in group A and B. Conclusion: Oral candidiasis, oral hairy leukoplakia, linear gingival erythema, necrotizing ulcerative gingivitis, and necrotizing ulcerative periodontitis are specific oral indicators which will definitely suggest to the dental surgeon that the disease is running a rapid downhill course and due to this the oral physician is in a position to raise a suspicion and alert the general physician regarding the declining immune status of patient.

Incidence of herpes simplex virus type 2 in young reproductive age women in Mysore, India.

Context: There are sparse data on herpes simplex virus type 2 (HSV-2) infection in India. HSV-2 is one of the most common sexually transmitted infections and the primary cause of genital ulcer disease worldwide. Aim: The aim of this study is to describe the incidence of HSV-2 infection among young reproductive age women in Mysore, India. Setting and Design: Between October 2005 and April 2006, 898 women were enrolled into a prospective cohort study in Mysore, India, and followed quarterly for 6 months. Materials and Methods: An interviewer administered questionnaire was used to collect demographic and social risk factors, and physical examination was conducted for collection of biological specimens to screen for reproductive tract infections at each visit. Serologic testing was conducted for the presence of HSV-2 antibodies using HerpeSelect HSV-2 enzyme-linked immunosorbent assay. Statistical Analysis Used: Data were analyzed using R. Incidence density rates were calculated using Poisson distributions with person-time of follow-up as denominator. Person-time was calculated as time from enrollment until time of first positive HSV-2 test. Results: There were 107 women with HSV-2 antibodies leaving 700 women with negative results at enrollment. The analysis included 696 out of which, there were 36 HSV-2 seroconversions during the study period. The study cohort accumulated roughly 348 woman-years of follow-up, yielding an HSV-2 acquisition rate of 10.4 cases/100 woman-years. All detected infections were asymptomatic. Conclusions: HSV-2 incidence is moderate in this community sample of young reproductive age monogamous women. More research is needed to establish incidence estimates in different Indian settings.

Seroprevalence of herpes simplex virus-2 in kidney transplant recipients: a single-center experience

Viral infections are a real threat in kidney transplant recipients because of their immunocompromised condition. This study aimed to evaluate herpes simplex virus-2 [HSV-2] seropositivity among kidney transplant recipients. Serum samples of 91 kidney transplant recipients from Urmia, Iran, were examined serologically for antibodies against HSV-2 using an enzyme-linked immunosorbent assay. The mean time from transplantation at HSV-2 testing was 5.04 +/- 4.45 years. The anti-HSV-2 immunoglobulin G antibody was positive in 5.4% of the kidney transplant recipients. Seropositive patients did not present any clinical manifestations of genital herpes infection. There was no association between HSV-2 seropositivity and age, gender, history of hemodialysis and transplantation, blood transfusion, or immunosuppressive regimen. Seroprevalence of HSV-2 is not high among our kidney transplant recipients. However, it remains a source of concern, considering the compromised immune system in this specific population

Co-infection of herpes simplex virus (HSV) with human immunodeficiency virus (HIV) in women with reproductive tract infections (RTI).

In India, HSV seroprevalence and its coinfection with HIV among female patients with reproductive tract infections (RTI) are sparse. We aim to ascertain the seroprevalence of HSV and its coinfection with HIV and common sexually transmitted infections attending Obstetrics and Gynaecology outpatient department, RIMS. The study included 92 female patients with RTI. Diagnostic serology was done for HSV-1 and HSV-2 using group specific IgM indirect immunoassay using ELISA, HIV by 3 ELISA/Rapid/Simple (E/R/S) test of different biological antigen. Diagnosis of RTI was made on clinical grounds with appropriate laboratory investigations--microscopy, Gram stain smear etc. Bacterial vaginosis was diagnosed using Nugent's criteria, Syphilis by rapid plasma reagin (RPR) card test and Chlamydia trachomatis by IgG ELISA. Out of 92 sera tested for HSV, 18 (19.6%) were IgM HSV positive and 9 (9.8%) were HIV positive. Co-infection rate of HSV in HIV positive was 16.7%. None of the patients had clinical herpes genitalis, all were subclinical cases. 55.5% of HSV positives belongs to age group 21 to 30 years. Of the HSV-1 and HSV-2 IgM positives 3 (15%) had HIV, 4 (22.2%) bacterial vaginosis, 2 (11.1%) were RPR positive, 4 (22.2%) Chlamydia trachomatis, 3 (15%) were pregnant. 16 (88.8%) were unemployed, 14 (77.7%) had education level below 10 standard. Our study suggest that every case of RTI, be it an ulcerative or nonulcerative must be thoroughly evaluated by laboratory testing for primary subclinical genital HSV coinfection as this has profound implications on their judicious management and aversion of complications. Early diagnosis and treatment of HSV infection together with prophylaxis for recurrent HSV disease will prevent progression and spread of HIV disease.

Herpes simplex virus 2 infection: a risk factor for HIV infection in heterosexuals.

BACKGROUND: Genital ulcerative disease is one of the risk factors for acquisition of HIV. As HSV-2 infection is currently the most common cause of genital ulcerative disease, it acts as a potential risk factor for HIV infection. The present study was undertaken to know the seroprevalence of antibodies to HSV-2 in HIV seropositive individuals and in the general population, and to ascertain if HSV-2 is a risk factor for developing HIV infection. METHODS: The study group included one hundred new HIV seropositive persons irrespective of active genital herpes or history of genital herpes. Fifty age- and sex- matched healthy volunteers were included as controls. In all patients and controls, diagnostic serology was done for HSV-2 using HSV-2-specific glycoprotein IgG2 by indirect immunoassay using the ELISA test. Statistical value 'P' was calculated using the Chi-squared test. RESULTS: Out of the 100 HIV seropositives, 66 were males and 34 were females with an age range of 20-54 years. In only 22 (19 males and 3 females) of these, positive history of genital herpes was obtained. In 49 out of the 100 HIV seropositives, IgG2 antibodies against HSV-2 were detected. In the control group, 11 out of 50 controls were seropositive for HSV-2 IgG2 antibody. There was a statistically significant association between HSV-2 and HIV seropositivity with 'P' value CONCLUSION: The high prevalence of HSV-2 seropositivity in the HIV-infected group (49%) as compared to normal controls (22%) was statistically significant. Prior HSV-2 infection could be an important risk factor for acquisition of HIV in our patients.

Prevalence and correlates of bacterial vaginosis among young women of reproductive age in Mysore, India.

PURPOSE: Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge among women of childbearing age and is associated with STI/HIV and adverse birth outcomes. The objective of this study was to determine the prevalence and correlates of BV among young women of reproductive age in Mysore, India. METHODS: Between October 2005 and December 2006, 898 sexually active women of 15-30 years of age were enrolled from two reproductive health clinics in Mysore. The women underwent an interview followed by physical examination, HSV-2 serologic testing, endocervical culture for Neisseria gonorrhoeae , and vaginal swabs for diagnosis of BV, Trichomonas vaginalis infection and candidiasis. Statistical analyses included conventional descriptive statistics and multivariable analysis using logistic regression. RESULTS: Of the 898 women, 391 (43.5%) were diagnosed with >or=1 endogenous reproductive tract infection and 157 (17.4%) with >or=1 sexually transmitted infection. Only 863 women had Gram-stained vaginal smears available, out of which 165 (19.1, 95% confidence interval [CI]: 16.3%-22.2%) were found to have BV and 133 (15.4, 95% CI: 12.9%-18.3%) were in the 'intermediate' stage. BV was related to concurrent infections with T. vaginalis (odds ratio [OR]=4.07, 95% CI: 2.45-6.72) and HSV-2 seropositivity (OR=2.22, 95% CI: 1.39-3.53). CONCLUSIONS: In this population, the prevalence of BV at 19% was relatively low. Coinfection with T. vaginalis , however, was common. BV was independently associated with concurrent T. vaginalis infection and partner's alcohol use. Muslim women had reduced odds of BV as compared to non-Muslim women. Further research is needed to understand the role of T. vaginalis infection in the pathogenesis of BV and the sociocultural context surrounding the condition in India.

Community-based study on seroprevalence of herpes simplex virus type 2 infection in New Delhi.

PURPOSE: To determine the seroprevalence of herpes simplex virus type 2 (HSV-2) in two urban communities in Delhi and to correlate the presence of HSV-2 seroprevalence with sociodemographic profile, risk factors and presence of other reproductive tract infections (RTIs). METHODS: Men and women aged between 15-49 years from an urban slum and an urban middle class colony were invited to participate in the study. They provided interview information; blood for HSV-2, HIV and syphilis serology; first void urine specimens for diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis infection; and genital specimens for diagnosis of bacterial vaginosis, vaginal candidiasis and trichomoniasis. RESULTS: The prevalence of HSV-2 seropositivity was found to be 7 and 8.6% in men and women, respectively. HSV-2 seropositivity was found to be significantly associated with urban middle class community and older age. No statistically significant correlation was found between HSV-2 seropositivity and other laboratory-confirmed RTIs. CONCLUSIONS: The findings of our study indicate a relatively low prevalence of HSV-2 seropositivity and other sexually transmitted infections in the two communities that were studied.

Herpes Simplex Virus Type 2 Seroprevalence in Korea: Rapid Increase of HSV-2 Seroprevalence in the 30s in the Southern Part

To determine the characteristics of seroprevalence of herpes simplex virus type 2 (HSV-2) infection among Korean people, a cross-sectional study was conducted on three groups in 2004. The three groups consisted of the general public who visited public health centers, commercial sex workers (CSWs), and human immunodeficiency virus (HIV)-infected persons. Among the general public, HSV-2 seroprevalence rates for age under the 20s, in the 20s, 30s, 40s and the above 22.6%, 32.7% and 32.3%, respectively, which showed rapid increase of the rate in the 30s (p<0.0001). In case of the above of 19 yr old, women (28.0%) was higher than men (21.7%) (p<0.0001). The rate of CSWs (81.6%) was about 10 times higher than that of general women. In case of HIV-infected men (47.6%), the figure was about 2-3 times higher than that of general men. The low rate in the teens and the 20s proved that it is essential to develop sexually transmitted infections (STIs) prevention programs of education and publicity for them as a precaution measure. This study is the first major study of its kind on HSV-2 and would provide basic data for prevention of STIs including information about target groups subject to vaccination program.

Comparison of immunoassays for differentiation of herpes simplex virus type 1 and 2 antibodies

To asses the commercial available enzyme-linked immunosorbent assays [ELISA] for differentiation of herpes simplex virus type 1 [HSV-1] and type 2 [HSV-2] antibodies. The study was performed between January 1997 to November 2002 in the Division of Virology, Department of Pathological Sciences, Central Manchester Healthcare Trust and University of Manchester, Manchester, United Kingdom. Assays based upon type-specific glycoprotein G-1 [gG-1] for HSV-1, and glycoprotein G-2 [gG-2] from HSV-2 were evaluated to differentiate between HSV-1 and HSV-2 antibodies. Using 5 different ELISA tests, 2 panels of serum samples were tested. Panel one consisted of 88 sera, selected from the serum bank of the Clinical Virology Laboratory, Manchester Royal Infirmary; panel 2 comprised of 90 sera selected from samples collected from Bangladeshi female commercial workers. The data of this study showed that a high rate of gG-1 based immunoassays ranged from 87.9-100% for sensitivity and 51.5-100% specificity. Although there are several immunoassays were claimed to differentiate between HSV-1 and HSV-2 antibodies, selection of these assays should be carefully interpreted with the overall clinical framework provided by detailed sexual history and genital examination

Seroprevalence of HSV1 and HSV2 infections in family planning clinic attenders.

Few studies from India documented seroprevalence of HSV 1 and 2 infection in different population groups. We determined HSV 1 and 2 seroprevalence in a cohort of adults 16-40 year of age, attending the family planning clinic. For the overall study population, 63% were seropositives, 33.3% for HSV 1 alone. 16.6% for HSV 2 and 13.3% had mixed infection. By the statistical analysis, the mean age difference between the two sexes for either infection was not significant. HSV-2 seroprevalence was associated with an increasing age. Men were more likely than women to be seropositive for HSV2. More studies from India are required to coroborate our findings.

Increase of genital HSV-1 and mixed HSV-1 and HSV-2 infection in Bangkok, Thailand.

From January 1998 to December 2004, 207 out of 1125 samples were HSV isolation positive and typed. Two groups of patients, Thai and foreigner, as well as site of infection, non-genital and genital area, were identified. The prevalence of non-genital HSV-1 infection from 27 samples of Thai patients was 81.84%. Out of 180 genital samples, 39.02% HSV-1 and 43.09% HSV-2 from 123 Thai patients and 36.84% HSV-1 and 49.12% HSV-2 of 57 foreigner patients were determined. Moreover mixed infection of HSV-1 and HSV-2 was found in both Thai and foreigner groups, 17.89% and 14.04%, respectively. The prevalence of genital HSV-1 infection in Thai patients chronologically increases from 1.6% to 56.91% from of 1985 to 2004. Increase of HSV-1 genital infection and mixed HSV-1 and HSV-2 infection in Thai people might probably be due to changing of sexual behavior in the AIDS era.

Induction of apoptosis by herpes simplex virus in Jurkat cells is partly through caspase-3, -8 and -9 activation.

Herpes simplex virus (HSV), a large DNA containing virus, is endemic in all human populations investigated. After infection of mucocutaneuos surfaces, HSV establishes a latent infection in nerve cells. Various immune evasion mechanisms have been shown to be utilized by HSV including apoptosis induction in Tlymphocytes. However, the mechanisms of T cell infection and apoptosis by HSV are still unknown. The present study investigated the molecular mechanisms of apoptosis induction in T cells by HSV The Jurkat T cell line was used as a representative for T cells. Apoptosis detection by Annexin Vassay demonstrated that both HSV-1 and HSV-2 induced apoptosis in Jurkat cells and caspase-3, -8, and -9 inhibitors blocked apoptosis induced by HSV-1 and HSV-2. The data suggested that HSV-1 and HSV-2 induced apoptosis in T lymphocytes by caspase-dependent pathway. However, apoptosis may occur through other mechanism(s) since caspase inhibitors used in the present study could not completely inhibit apoptosis induced by HSV infection. In addition, the data demonstrated that the number of apoptotic cells induced by HSV-2 was significantly higher than byHSV-1 at 12 hour post-infection (h p.i.) (p = 0.003). Further studies in peripheral blood T cells and the proteins of viruses involved in apoptosis induction should be further performed in order to elucidate the molecular mechanisms of apoptosis induced by these viruses.

Role of serology in the diagnosis of herpes simplex encephalitis.

Twenty one cerebrospinal fluid (CSF)/brain tissue (16 CSF and 5 brain tissue) from patients clinically suspected of herpes simplex encephalitis (HSE) were collected during one year period and was subjected for the detection of HSV type I and type II antigen by direct Immunofluorescence (DIF). Paired serum and CSF samples obtained from 12 patients were tested for herpes simplex virus antibodies by indirect immunofluorescence test. Of the 21 cases, two were positive for HSV-1 antigen in CSF and one in brain tissue by DIF. Virus specific IgG antibody in paired CSF and serum samples was positive in one case only. In none, virus could be grown in verocell line. In 2 Patients antemortem diagnosis was possible and parenteral acyclovir could be administered in one case that recovered following treatment. Thus, besides antibody detection, direct immunofluorescence is an useful and rapid method for the early diagnosis of HSE.

Herpes simplex virus type-2, cytomegalovirus and Epstein-Barr virus infection in acute non A to E hepatitis Thai patients.

A significant number of acute non A to E hepatitis cases are reported in Thailand every year, and the etiologies of these cases are unknown. Members of the herpesviridae family have been reported to cause either a self limited or fatal hepatitis in a small proportion of patients in other parts of the world. To determine whether herpesviruses may play a role in acute non A to E hepatitis, sera from 32 acute hepatitis patients without markers for acute hepatitis A to E virus infection were examined for IgM to herpesvirus type 2 (HSV-2), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) using commercially available assays. IgM to HSV-2 was detected in four sera, IgM to CMV was detected in one serum, and IgM to EBV was detected in one serum. All of the acute non A to E hepatitis patients recovered and none had underlying conditions associated with impaired immunity. These results suggest that herpesviruses should be considered in the differential diagnosis for Thai patients with hepatitis.

Sero-prevalence of herpes simplex virus type-2 among cancer cervix patients.

Serum samples were collected from 140 cancer cervix patients aged between 25-60 years and also from 20 age matched, married, healthy women to serve as controls. These sera were tested for HSV-2 antibodies by ELISA test and HBsAg by RPHA test. HSV-2 antibodies were detected in 92 (65-71%) and HBsAg in 25 (17.8%) cancer cervix patients. Sera from control group were negative for HSV-2 antibodies and HBsAg.

Estudio serológico de HV2 e inmunocitoquímico de HPV2 y HPV en displasia y neoplasia / Serologic study of HV2 and immunocytochemistry of HPV2 and HPV in dysplasia and neoplam

Se hace una revisión de la alta incidencia y prevalencia del cáncer cérvico uterino en el Perú, así como una revisión de trabajos publicados sobre factores de riesgo, estudio epidemiológico, etc. dando énfasis a la importancia actual del Herpes Virus Humano tipo 2 y el Papiloma Virus Humano mucotrófico. De una encuesta epidemiológica-citológica en 70,094 mujeres en riesgo de presentar cáncer de cuello uterino de la Costa, Sierra y Selva del Perú se encontró mediante estudio serológico de Inmunofluorescencia, anticuerpos para HV2 en el 100 por ciento de las mujeres portadoras de Displasia y Neoplasia en comparación al 10 por ciento del grupo control. Utilizando técnica de Inmuno peroxidasa-antiperoxidasa se demostró en las células exfoliadas del tracto cérvico vaginal del antígeno del Papiloma Virus Humano en el 9 por ciento de las Displasias y en 6.3 por ciento de la Neoplasia. Se encontró la presencia de HV2 y HPV simultáneamente en el 8.8 por ciento de las Displasias y 4.5 por ciento de la Neoplasia utilizando las técnicas ya mencionadas.