ABSTRACT
Human immunodeficiency virus (HIV) infection is associated with a wide spectrum of systemic and ocular infectious diseases. Little is known about its association with herpes simplex keratitis (HSK) in this geographical region (South India). A retrospective study was undertaken to analyze this association in a cohort of 30 virologically proven recurrent HSK cases. Laboratory methods included herpes simplex virus (HSV) isolation, HSV antigen detection and tear secretory IgA or HSV DNA detection while commercial ELISA kits detected HIV infection. The rationale behind the HIV screening was to assess the role of HIV with increased HSK recurrences. Confirmed HIV seropositivity was 16.7% in recurrent HSK cases as against 3.3% in the matched first-episode HSK cases (p < 0.05, Fisher's exact test). Our observations on the features of herpetic keratitis in HIV-proven patients, though based on a small number of cases, raise the question whether the immunological abnormalities associated with HIV/AIDS may affect the clinical course of HSK.
Subject(s)
AIDS-Related Opportunistic Infections/virology , DNA, Viral/analysis , HIV Antibodies/analysis , HIV Antigens/analysis , HIV , Keratitis, Herpetic/virology , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/epidemiology , Adult , Blotting, Western , Corneal Stroma/virology , Enzyme-Linked Immunosorbent Assay , Fluorescent Antibody Technique, Indirect , HIV/genetics , HIV/immunology , HIV/isolation & purification , Humans , Immunoglobulin A, Secretory/metabolism , India/epidemiology , Keratitis, Herpetic/diagnosis , Keratitis, Herpetic/epidemiology , Male , Polymerase Chain Reaction , Prevalence , Recurrence , Retrospective Studies , Simplexvirus/genetics , Simplexvirus/immunology , Simplexvirus/isolation & purification , Tears/metabolismABSTRACT
In a South Indian study, an 'in-house' enzyme-linked immunosorbent assay (ELISA) was developed to evaluate the potential of herpes simplex virus (HSV)-specific tear secretory IgA (sIgA) in the diagnosis of herpes simplex keratitis (HSK). The presence of HSV-specific tear sIgA was found to be diagnostic in 20.28% of cases. The usefulness of the sIgA ELISA system was evaluated against HSV isolation, which is the 'gold standard' and HSV antigen detection, a more sensitive, commonly employed method. Analysis of HSV-specific IgG and IgM results showed their failure as reliable indicators of active or ongoing infection. Comparison of sIgA ELISA with culture as 'gold standard' showed its sensitivity, specificity, and positive and negative predictive values to be 60% (95% CI 36.4-80), 93.2% (95% CI 86.7-96.8), 60% (95% CI 36.4-80), and 93.2% (95% CI 86.7-96. 8), respectively. This study is the first report on the complete evaluation of the usefulness of tear anti-HSV sIgA in the laboratory diagnosis of HSK, taking into account both epithelial and stromal keratitis cases.