Investigating a viral etiology for keratoconjunctivitis sicca among patients who are positive for human immunodeficiency virus

Purpose. Herpesvirus infection of the lacrimal gland was investigated as an etiologic factor for keratoconjunctivitis sicca in patients who were posit ive for human immunodeficiency virus (HIV). Methods. In this cross-sectiona l study, we recorded the Schirmer tests and tear break-up times (TBUTs) amo ng 30 patients who were positive for HIV. Dry-eye state was defined as a Sc hirmer test of <10 mm of wetting at 5 min or a TBUT of <10 s. The polymeras e chain reaction assay (PCR) for herpes family viruses [Epstein-Barr virus (EBV), cytomegalovirus (CMV), herpes simplex virus (HSV), and varicella-zos ter virus (VZV)] was performed on the conjunctival and tear specimens of th e 30 HIV-positive patients by using virus-specific single primers. We compa red the rates of virus DNA detection among dry-eye and non-dry-eye patients by calculating the odds ratio of detection for each virus. Results. The od ds ratio of viral DNA detection was adjusted for age, gender, race, CD4 cou nt, and duration of HIV positivity. The adjusted odds ratios of EBV DNA det ection among dry-eye to non-dry-eye patients were 1.30 (p = 0.79) and 0.97 (p = 0.98) by using Schirmer tests and TBUTs, respectively. For CMV, the ad justed odds ratios among dry-eye to non-dry-eye patients were 1.94 (p = 0.5 8) with Schirmer tests and 1.02 (p = 0.99) with TBUTs. HSV and VZV DNA were not detected in any samples. Conclusion. Our study does not support the ro le of herpesvirus infection of the lacrimal gland as a causative factor in the pathogenesis of dry eyes in patients positive for HIV.