African Journal of AIDS and HIV Research
African Journal of AIDS and HIV Research ISSN 2326-2691 Vol. 8 (10), pp. 001-006, October, 2020. © International Scholars Journals
Full Length Research paper
Human herpes viral central nervous system infection in human immunodeficiency virus (HIV) and non-HIV patients: An 18-month prospective study
Kanokwan Pattanapongpaiboon1 and Subsai Kongsaengdao1, 2*
1Division of Neurology, Department of Medicine, Rajavithi Hospital, Department of Medical Services, Ministry of Public Health, Bangkok 10400, Thailand.
2Department of Medicine, College of Medicine, Rangsit University Bangkok, 10400 Thailand.
Accepted 25 April 2020
Human herpes virus (HHV) infection of the central nervous system (CNS) is a common problem worldwide. The incidence of HHV-CNS infection in human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) patients and non-HIV patients has been studied at Rajavithi Hospital, Bangkok, Thailand. To identify the prevalence and incidence of HHV1 (HSV), HHV3 (VZV), HHV4 (EBV), HHV5 (CMV), HHV6A,B, and HHV 7-CNS infection, and to differentiate the clinical manifestations, laboratory findings between HSV-encephalitis and non-HSV/HHV-CNS infection amongst patients at Rajavithi Hospital, Bangkok, Thailand. An 18-month prospective study of patients with clinically suspected CNS infection was enrolled. Cerebrospinal fluid (CSF) examination and culture, along with real time polymerase chain reaction (RT-PCR) for HSV-1, HHV3, HHV4, HHV5, HHV6, HHV7 and Mycobacterium tuberculosis were performed. Criteria for diagnosis of HHV-CNS infection included fever, headache, seizure, alteration of consciousness, neurological localizing signs and/or neck stiffness. A total of 94 patients, 52 male and 42 female, aged between 16 - 77 years (mean + SD = 42.3 + 14.5) were enrolled between July 2008 - December 2009. Forty four patients were confirmed to be HIV/AIDS positive. Of this, 27% were treated with highly active antiretroviral treatment (HAART). There was significant difference of age and gender between the HIV/AIDS subgroup versus the non-HIV subgroup (p < 0.026). The incidence of HHV encephalitis was 11.3% per-year. The incidence of HHV1 (HSV) viral encephalitis, HHV5 (CMV) latent infection, and HHV4 (EBV) encephalitis accounted for 5.67, 4.2 and 0.6% per year, respectively. There were no HHV6A, B, HHV7- CNS infections observed. The incidence of HHV encephalitis was noticeably higher in HIV/AIDS patients (p = 0.002). The CSF /blood sugar ratio observed in HSV1 encephalitis was higher than in non HSV/HHV-CNS infected patients (p = 0.06). Human herpes virus, especially HSV-CNS infection was found to be common in both HIV/AIDS and non HIV patients. The incidence of VZV, EBV, HHV6 and HHV7- CNS infection were rare. Unlike the CSF/blood sugar ratio and CSF pleocytosis, clinical manifestations may not be helpful for differentiation between HSV encephalitis and non HSV/HHV-CNS infection.
Key words: Human herpes virus (HHV), central nervous system (CNS) infection, human immunodeficiency virus (HIV), viral encephalitis, herpes simplex virus (HSV), varicella zoster virus (VZV), Ebstein barr virus (EBV).
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