Herpes virus shedding in people living with HIV hospitalized with acute illness: A pilot study

Background Asymptomatic shedding of herpes simplex virus type 2 (HSV-2) and cytomegalovirus (CMV) could be detrimental among people living with HIV (PLWH) hospitalized with acute illness, and clinical trials of suppressive antivirals may be warranted if so. However, the acceptability of serial viral shedding assessments in this setting is unclear. Methods We assessed the feasibility of quantifying subclinical HSV-2 and CMV reactivations in a pilot cohort study among PLWH hospitalized with acute illness. Consenting participants provided up to six serial oral, genital and anal mucosal swabs for HSV-2 detection by polymerase chain reaction (PCR) and blood for HSV-2 and CMV PCR. Results Of 81 persons approached, 45 (56%) consented. Most were cisgender men (89%) and were seropositive for HSV-2 (64%), CMV (89%), or both (62%). Median age was 47 (41-52) years and CD4 count was 146 (40-338) cells/mm 3 . Over a median (interquartile range) of 2 (1-3) assessments each, 42% of participants with HSV-2 experienced mucosal HSV-2 shedding, 16% had detectable HSV-2 viremia at least once and 33% of CMV seropositive participants had CMV viremia at least once. Conclusions Serial collection of mucosal swabs and blood for HSV-2/CMV shedding appeared feasible among people living with HIV hospitalized with acute illness. The relationship between asymptomatic shedding and clinical outcomes warrants further study in this setting, to inform trial design.