Frequency of symptomatic and asymptomatic herpes simplex virus type 2 reactivations among human immunodeficiency virus-infected men

Herpes simplex virus (HSV) infection is common in persons coinfected with h uman immunodeficiency virus (HIV), In a prospective study, daily viral cult ures of the mouth, genitals, and rectum were collected from 68 HIV-positive and 13 HIV-negative men who have sex with men, Subjects completed a median of 57 days of follow-up. Anogenital HSV-2 cultures were positive on 405 (9 .7%) of 4167 days for HIV-positive men and on 24 (3.1%) of 766 days for HIV -negative men. Most reactivations were perirectal and subclinical, Risk fac tors for increased HSV-2 shedding among HIV-positive men were low CD4 cell count (odds ratio, 2.5; 95% confidence interval, 1.2-5.4) and antibodies to both HSV-1 and HSV-2 versus HSV-2 only (odds ratio, 1.9; 95% confidence in terval, 1.0-3.7), Three isolates obtained from 3 separate subjects were res istant to acyclovir, Thus, subclinical HSV-2 reactivation is an important o pportunistic infection in persons with HIV infection. Further studies are n ecessary to determine the impact of subclinical HSV-2 reactivation on the n atural history of HIV infection.