What are the signs and symptoms of herpes simplex virus (HSV) infection in HIV infection?

Updated: Jul 21, 2021
  • Author: Luca Rosignoli, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Clinical features of HSV infection that distinguish it from VZV infection include the following:

·       Incomplete dermatomal distribution

·       Larger dendrites with central ulceration and terminal bulbs

·       Rare skin scarring

·       Rare postherpetic neuralgia

·       Patchy iris atrophy

·       Rare bilateral involvement

Other conditions that may produce dendritic epithelial lesions include VZV, healing epithelial defects, and soft contact lens wear.

Diagnosis of HSV predominantly is based on clinical features and staining pattern with rose bengal and/or fluorescein. In the absence of such classic clinical features, tissue culture, and/or antigen detection techniques may be helpful.

Stromal keratitis occurs as a result of immunologic reaction to viral antigens. It can be subdivided into non-necrotizing (disciform or interstitial keratitis) or necrotizing. Both HSV and VZV can result in stromal keratitis.

Disciform keratitis primarily affects the corneal endothelium and presents with a deep annular lesion with overlying stromal edema. Keratic precipitates and a mild iritis can also occur. Interstitial keratitis presents with single or multiple stromal opacities without significant edema (since the corneal endothelium is usually not affected). Scarring and neovascularization can complicate both disorders.

Necrotizing herpetic keratitis presents and behaves similarly to bacterial or fungal keratitis with painful, progressive suppurative stromal infiltration and overlying epithelial defect. Progressive thinning can occur, with the potential of corneal perforation. Both HSV and VZV can result in this presentation.

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