Roseolovirus DNA in the Colonic Mucosa of HIV‐Seropositive Patients with Diarrhea

SIR—We read with great interest the recent article by Amo et al. [1], who reported the presence of human herpesvirus-6 (HHV-6) DNA in large intestine tissue specimens and PBMCs obtained from stem cell transplant recipients. These data are in agreement with the results we obtained from patients with diarrhea related to human immunodeficiency virus (HIV) infection, another cause of immunosuppression. Thirty-one HIV-1-seropositive patients with diarrhea were examined using left-side colonoscopy. The patients (30 men and 1 woman) belonged to different stages of HIV infection, had CD4+ T cell counts of 3–421 cells/mL (mean, 91 cells/mL), and were aged from 27–57 years (mean, 39 years). A biopsy sample of normal colonic mucosa was obtained from each of the 20 patients with normal-appearing mucosa. For the 11 patients with colonic lesions visible on endoscopy biopsy samples were obtained from the site with the most severe lesions. Nucleic acids were prepared from intestinal biopsy specimens by means of classical methods. Detection of human cytomegalovirus (HCMV), HHV-6, and human herpesvirus-7 (HHV-7) DNA was done with PCR with use of specific primers followed by hybridization with oligonucleotidic probes. HHV-6 strains were identified as variant A or variant B by means of PCR with use of variant-specific primers and hybridization with variant-specific probes. Of the 31 intestinal biopsy specimens tested, 15 (49%) tested positive for HCMV, 7 (23%) tested positive for HHV-6, and 22 (71%) tested positive for HHV-7 DNA (figure 1). The detection of any 1 virus was not significantly associated with the detection of any of the 2 others. The aspect of the colonic mucosa was normal in 20 patients (64.5%), erythematous in 7 (22.5%), and ulcerative in 4 (13%). There was no statistically significant association between the endoscopic aspect of the colonic mucosa and the detection of any virus. As in the publication from Amo et al. [1], all the HHV-6 strains detected were identified as variant B strains. Diagram showing virus DNA identified in colonic biopsy specimens from HIV-1-positive subjects with diarrhea. Data are no. (%) of patients. HCMV, human cytomegalovirus; HHV-6, human herpesvirus-6; HHV-7, human herpesvirus-7. HCMV has been previously associated with diarrhea. The precise role played in this disease—in particular, when HCMV is absent—by the 2 closely related viruses HHV-6 and HHV-7 has to be explored, and this will require further studies. Moreover, the question of viral interactions between all 3 betaherpesviruses should also be addressed, given that such interactions have been observed in patients who have undergone renal transplantation [2, 3].