Longitudinal study on oral shedding of herpes simplex virus 1 and varicella-zoster virus in individuals infected with HIV

Monique van Velzen, Werner J D Ouwendijk, Stacy Selke, Suzan D Pas, Freek B van Loenen, Albert D M E Osterhaus, Anna Wald, Georges M G M Verjans

    Research output: Contribution to journalArticleResearchpeer-review


    Primary herpes simplex virus 1 (HSV-1) and varicella-zoster virus (VZV) infection leads to a life-long latent infection of ganglia innervating the oral mucosa. HSV-1 and VZV reactivation is more common in immunocompromised individuals and may result in viral shedding in saliva. We determined the kinetics and quantity of oral HSV-1 and VZV shedding in HSV-1 and VZV seropositive individuals infected with HIV and to assess whether HSV-1 shedding involves reactivation of the same strain intra-individually. HSV-1 and VZV shedding was determined by real-time PCR of sequential daily oral swabs (n = 715) collected for a median period of 31 days from 22 individuals infected with HIV. HSV-1 was genotyped by sequencing the viral thymidine kinase gene. Herpesvirus shedding was detected in 18 of 22 participants. Shedding of HSV-1 occurred frequently, on 14.3% of days, whereas solely VZV shedding was very rare. Two participants shed VZV. The median HSV-1 load was higher compared to VZV. HSV-1 DNA positive swabs clustered into 34 shedding episodes with a median duration of 2 days. The prevalence, duration and viral load of herpesvirus shedding did not correlate with CD4 counts and HIV load. The genotypes of the HSV-1 viruses shed were identical between and within shedding episodes of the same person, but were different between individuals. One-third of the individuals shed an HSV-1 strain potentially refractory to acyclovir therapy. Compared to HSV-1, oral VZV shedding is rare in individuals infected with HIV. Recurrent oral HSV-1 shedding is likely due to reactivation of the same latent HSV-1 strain.

    Original languageEnglish
    Pages (from-to)1669-77
    Number of pages9
    JournalJournal of Medical Virology
    Issue number9
    Publication statusPublished - Sept 2013


    • Adult
    • DNA, Viral/chemistry
    • Female
    • Genotype
    • HIV Infections/complications
    • Herpes Simplex/virology
    • Herpes Zoster/virology
    • Herpesvirus 1, Human/isolation & purification
    • Herpesvirus 3, Human/isolation & purification
    • Humans
    • Longitudinal Studies
    • Male
    • Middle Aged
    • Molecular Sequence Data
    • Saliva/virology
    • Sequence Analysis, DNA
    • Viral Load
    • Virus Activation
    • Virus Shedding
    • Young Adult


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