Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
EPSTEIN-BARR AND OTHER VIRAL INFECTIONS
Infect Dis Ther; 3:215-28 1989. Unique Identifier : AIDSLINE ICDB/90665447 Jacobson MA; Dept. of Medicine, San Francisco General Hosp., San Francisco, CA
Abstract:
Epstein-Barr virus (EBV), progressive multifocal leukoencephalopathy (PML), and adenovirus infection in AIDS are reviewed, including the role of EBV in HIV-associated syndromes (non-Hodgkin's B-cell lymphoma, lymphoid interstitial pneumonia, and hairy leukoplakia); laboratory diagnosis of EBV (peripheral blood mononuclear cell transformation, oropharyngeal EBV excretion, direct detection of EBV DNA, and EBV serology); role of EBV in HIV-associated immune dysfunction; therapy for EBV; etiology, pathologic findings, clinical presentation and course, diagnosis, and therapy of PML; and characteristics of adenovirus infection in AIDS. Humoral and cellular immunity to EBV is augmented in most patients (pts) with HIV infection compared with healthy HIV-negative controls. Acyclovir inhibits EBV replication in vitro at concentrations of 10-25 umol, despite the fact that EBV may lack the thymidine kinase enzyme necessary for optimal drug phosphorylation. PML is a rare demyelinating disease affecting immunocompromised hosts, particularly pts with hematologic malignancies or AIDS. Partial remission has been described in several cases of PML in non-AIDS pts treated with cytosine arabinoside. There are two case reports of cytosine arabinoside therapy for pts with PML in AIDS; transient improvement occurred in one pt, and no detectable effect was seen in the other. Adenoviruses, like EBV and papovaviruses, are double-stranded DNA viruses with a propensity to establish persistent infection in humans. Adenoviruses may cause acute upper respiratory, ocular, or urinary tract infections in immunocompetent adults; however, infections are asymptomatic. Adenoviruses may persist in tonsillar lymphoid cells for long periods without causing disease. Recent studies have documented frequent isolation of an unusual adenovirus strain in the urine of pts with AIDS. The significance of this finding is unknown. This asymptomatic shedding could result from endogenous reactivation of latent virus. The rarity of the 34/35 serotype in the general population, however, argues against this hypothesis. Perhaps pts with HIV infection become uniquely susceptible to colonization with this serotype. Recent evidence suggests that the group D adenovirus may be an opportunistic pathogen in pts with AIDS and colitis. Although adenovirus is occasionally isolated from colonic biopsies of pts with cytomegalovirus (CMV) colitis, some colonic biopsy cultures are negative for CMV but positive for adenovirus. (69 Refs)
Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS/DIAGNOSIS Adenovirus Infections, Human/COMPLICATIONS Burkitt's Lymphoma/COMPLICATIONS Diagnosis, Differential Herpesviridae Infections/*COMPLICATIONS Herpesvirus 4, Human/PATHOGENICITY Human HIV Infections/*COMPLICATIONS/DIAGNOSIS Leukoencephalopathy, Progressive Multifocal/COMPLICATIONS Opportunistic Infections/*COMPLICATIONS/DIAGNOSIS Tumor Virus Infections/*COMPLICATIONS/DIAGNOSIS JOURNAL ARTICLE REVIEW, TUTORIAL REVIEW 901030
M90A0689
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Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
