ASYMPTOMATIC PERIANAL SHEDDING OF HERPES-SIMPLEX VIRUS IN PATIENTS WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME

Objective: To determine the frequency of asymptomatic perianal sheddin g of herpes simplex virus (HSV) in adult patients with acquired immuno deficiency syndrome (AIDS). Design: Cross-sectional study. Setting: A 1000-bed, state-supported hospital in Brazil that provides comprehensi ve health care. Patients: Eighty-two consecutively hospitalized patien ts with AIDS (Centers for Disease Control and Prevention class C). Mai n Outcome Measurement: Specimens for HSV culture were obtained with pr emoistened swabs of the perianal region at approximately 7-day interva ls during the hospitalization of each patient. After the specimens wer e inoculated into cultures of human foreskin and Vero cells, supernata nts of cultures showing the cytopathic effect characteristic of HSV in fection were tested for virus in a confirmatory immunoenzymatic assay. Typing of HSV was performed by polymerase chain reaction amplificatio n of HSV-1- and HSV-2-specific DNA polymerase sequences. Results: On e ntry into the study, 12 (15%) of 82 patients had perianal ulceration a nd 70 did not. None of the patients in the latter group developed peri anal ulcers during the study period, but HSV was isolated at least onc e from 17 (24%) of them. Nine of the 17 asymptomatic perianal shedders had a mean of 3 perianal swabs collected before the first HSV isolati on, and 11 (65%) of 17 had a total of 18 perianal swabs collected 8 to 62 days after the HSV isolation. All postpositive samples were negati ve for HSV except 1 obtained from a patient 13 days after the first po sitive sample. Twelve of the 17 asymptomatic perianal shedders of HSV were followed up clinically for 8 to 62 days after the first episode o f shedding, and none developed perianal ulceration. Conclusions: We co nclude that asymptomatic perianal shedding of HSV is common in patient s with AIDS, even among those without a history of perianal HSV lesion s. This shedding appears to be short-lived, intermittent, and not asso ciated with early subsequent development of perianal ulcers. These fin dings present a new perspective on the natural course of perianal HSV infection in patients with AIDS.