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

Updated: Jul 21, 2021
  • Author: Luca Rosignoli, 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, cases of HSV-2 causing ocular infections and HSV-1 causing genital infections have been reported. 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. Varicella-zoster virus (VZV) and herpes simplex virus (HSV) are the most common causes of infectious keratitis in HIV-positive patients, and the incidence of herpetic keratitis is higher in HIV-positive patients than in the general US population. Keratitis due to VZV usually is associated with herpes zoster ophthalmicus, with or without the presence of dermatitis. VZV keratitis occurs in fewer than 5% of patients who are HIV positive, but it may cause permanent visual loss. 

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