Oral shedding of herpesviruses in HIV-infected patients with varying degrees of immune status

Objective: Herpesvirus shedding in the oral cavity was analyzed to determine if presence in the oral compartment correlates with systemic changes in HIV-associated immune deficiency as measured by CD4 + cell counts, plasma HIV viral load and presence of AIDS-defining events. Design: A5254 is a multicenter, cross-sectional, single-visit study to evaluate oral complications of HIV/AIDS and determine the association between clinical appearance, herpesvirus shedding, and immune status as ascertained by CD4 + cell count and HIV viral load. In total, 307 HIV-infected individuals were evaluated and throat wash collected. Methods: Fisher's exact test and Kruskal-Wallis test were used to assess the association between presence of herpesviruses and the state of immunodeficiency as stratified by a combination of CD4 + cell count and HIV viral load. Relationship between pathogens and HIV viral load in plasma was modeled by logistic regression. Results: The presence of cytomegalovirus (CMV) and herpes simplex virus-1 in throat wash was associated with decreased CD4 + cell counts. By contrast, Kaposi sarcoma-associated herpesvirus and Epstein-Barr virus were similarly detectable across all levels of CD4 + cell counts. One unit increase in log 10 (HIV viral load) was associated with 1.31 times higher odds of detecting CMV in throat wash when controlling for oral candidiasis, CD4 + cell count, and sites (95% confidence interval 1.04-1.65, P=0.02). Conclusion: Oral CMV shedding was significantly higher in highly immunocompromised HIV + participants. Our finding supports the recommendations to start antiretroviral therapy independent of CD4 + cell count as this may have the added benefit to lower the risk of herpesvirus transmission among persons infected with HIV and their partners.