Subclinical reactivation of varicella zoster virus in all stages of HIV infection.

Subclinical reactivation of varicella zoster virus in all stages of HIV infection.
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DOI:
10.1016/j.jns.2011.02.030
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发表时间:
2011-05-15
影响因子:
4.4
通讯作者:
Cohrs, Randall J.
Cohrs, Randall J.
中科院分区:
医学3区
文献类型:
--
作者:
Birlea, Marius;Arendt, Gabriele;Orhan, Eser;Schmid, D. Scott;Bellini, William J.;Schmidt, Christian;Gilden, Don;Cohrs, Randall J.

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对来自180名HIV阳性个体(其中136名患有AIDS)的200对血清和脑脊液(CSF)样本进行分析,发现28名(16%)个体鞘内合成水痘带状疱疹病毒(VZV)特异性抗体,15名(8%)个体鞘内合成麻疹病毒特异性抗体,1名(0.6%)个体鞘内合成单纯疱疹病毒-1(HSV-1)特异性抗体,无HSV-2特异性抗体。在28例VZV抗体特异性指数阳性的受试者中,仅1例在血清和CSF采样时出现带状疱疹;在总计180例HIV阳性受试者中,146例(81%)无带状疱疹病史。根据全球估计的3340万HIV阳性个体,在甚至不到16%的HIV阳性人群中VZV的亚临床再激活表明数百万人可能患有中枢神经系统的活动性VZV感染。在VZV血管病、脊髓病甚至无疱疹性带状疱疹的病例中,脑脊液中抗VZV抗体常为阳性,而VZV DNA常为阴性。为了排除神经系统的VZV感染,必须检测CSF中的VZV DNA和抗VZV IgG和IgM抗体。
Analysis of 200 paired serum and cerebrospinal fluid (CSF) samples from 180 HIV-positive individuals, 136 of whom had AIDS, revealed intrathecal synthesis of antibodies specific for varicella zoster virus (VZV) in 28 (16%) individuals, measles virus in 15 (8%), herpes simplex virus-1 (HSV-1) in 1 (0.6%), and HSV-2 in none. Of the 28 subjects with a positive VZV antibody specificity index, only 1 had zoster rash at the time of serum and CSF sampling; of the total 180 HIV-positive subjects, 146 (81%) had no history of zoster. Based on an estimated 33.4 million HIV-positive individuals worldwide, subclinical reactivation of VZV in even less than 16% of HIV-positive people suggests the possibility that millions of people have active VZV infection of the central nervous system. In cases of VZV vasculopathy, myelopathy and even zoster sine herpete, the CSF is often positive for anti-VZV antibody, but negative for VZV DNA. To rule out VZV infection of the nervous system, CSF must be tested for VZV DNA and anti-VZV IgG and IgM antibody.
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