What is the role of herpes simplex virus keratitis in the ocular manifestations of HIV infection?

Updated: Jun 12, 2019
  • Author: Robert A Copeland, Jr, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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HSV is a DNA virus that often infects humans. Two strains of HSV exist: HSV-1 and HSV-2.

In the United States, approximately 50-90% of adults have serum antibodies to HSV-1. HSV infection is spread by direct contact with infectious secretions from infected carriers. HSV-1 is commonly responsible for oral and ocular infections, while HSV-2 is responsible for genital infections. However, some cases of HSV-2 causing oral or ocular infections and of HSV-1 causing genital infections have been reported.

Like VZV, HSV can establish latency after primary infection with subsequent reactivation of the disease when the host individual's immune system is compromised. Following primary infection, HSV may spread from the epithelial site of infection to sensory nerve endings in the infected tissue; from there, the virus is transported up the nerve axon to the cell body.

In the cell body, the viral genome enters the nucleus, where it persists in a latent nonpathogenic state until reactivation in a pathogenic or immunocompromised state. Following reactivation, HSV is transported down the nerve axon to the epithelial cells on the ocular surface or cornea.

About 0.15% of the population has a history of external ocular HSV infection, and approximately 67% of patients with HSV infections develop epithelial keratitis. The prevalence of HSV keratitis is higher in HIV-infected patients than in the general US population.

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