Seroprevalence of herpes simplex virus infections in elderly patients infected with HIV: the need for early herpes simplex suppressive therapy
M. Ruiz1, C. Briones2
1Louisiana State University, Medicine/Section of Infectious Diseases/Section of Geriatric Medicine, New Orleans, United States, 2Cayetano Heredia University, Department of Medicine, San Martin, Peru
Background: Herpes infection is a worldwide problem and represents a significant public health problem. Reports indicate an increased seroprevalence of herpes simplex infections (HSV 1 and HSV 2) in elderly patients with a peak of HSV-2 seroprevalence in elderly male patients. Chronic suppressive HSV therapy in elderly HIV-infected patients upon serum diagnosis in order to prevent interactions between HSV and HIV viruses has not been studied.
Methods: We retrospectively review the charts of patients >60 years (160 cases) who regularly attend our clinic. As of September 2009 there were around 1800 active patients in our HIV outpatient clinic.
Results: 28 cases of either genital or labial herpes simplex infections were found. Diagnoses and treatment were made based on clinical grounds. 75% were males and 25% females. Average age was 61.4 years (60-67), CD4 count ranged from 6-to1198 cells/ml, viral load ranged from < 50- to 1'794,517 copies/ml). Almost 72% of patients were on antiretroviral therapy at any time. 43% of patients were treated episode-based, 29% were on chronic suppressive therapy, and 28% were not on any form of treatment. 14% of patients also had either a positive syphilis test or Chlamydia/gonorrhea test.
Conclusions: HSV seroprevalence reports in different studies vary from 50% to 80% for men and women respectively. The few studies in elderly patients indicate that aging is a risk factor for increased seroprevalence. There are significant interactions between HSV and HIV viruses that could increase the burden of disease in elderly HIV-positive patients. HSV-1 and HSV-2 suppressive therapy have been studied in numerous trials and the results of benefits of HSV suppression on HIV infection are mixed. We suggest that upon serodiagnosis of HSV chronic suppressive therapy and antiretroviral therapy should be started on elderly HIV-patients in order to avoid potential complications.
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