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

Oral shedding of herpesviruses in HIV-infected patients with varying degrees of immune status.
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Dittmer DP, Tamburro K, Chen H, Lee A, Sanders MK, Wade TA, Napravnik S, Webster-Cyriaque J, Ghannoum M, Shiboski CH, Aberg JA,


Dittmer DP, Tamburro K, Chen H, Lee A, Sanders MK, Wade TA, Napravnik S, Webster-Cyriaque J, Ghannoum M, Shiboski CH, Aberg JA, (click to view)

Dittmer DP, Tamburro K, Chen H, Lee A, Sanders MK, Wade TA, Napravnik S, Webster-Cyriaque J, Ghannoum M, Shiboski CH, Aberg JA,

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AIDS (London, England) 31(15) 2077-2084 doi 10.1097/QAD.0000000000001589

Abstract
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 log10 (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.

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