Objectives: To compare histological with genome detection methods for diagn
osis of herpesvirus infection in eye and brain of HIV infected patients und
ergoing necropsy and to correlate these findings with both antemortem clini
cal findings and postmortem evidence of extraocular herpesvirus infection,
especially in the CNS.
Methods: A prospective study of 31 consecutive HIV infected patients underg
oing necropsy. In life 11 patients had been assessed by an ophthalmologist
because of ocular symptoms. Ocular and brain samples were examined for herp
esviruses by conventional histological methods and by nested polymerase cha
in reaction (nPCR) for all eight human herpesviruses; evidence of extraneur
al herpesvirus infection was sought by histological methods.
Results: Although only 12 out of 31 patients (39%) had antemortem clinical
evidence of ocular or CNS herpesvirus associated disease, herpesviruses wer
e detected by nPCR in eye and brain from 26 (84%) patients; six patients ha
d more than one herpesvirus infection. There was concordance between ocular
and CNS findings in 15 of 19 patients (79%) with CMV infection. 17 of 31 p
atients (55%) had extraocular or CNS CMV infection at necropsy. Genome dete
ction using nPCR was superior to histological methods for diagnosis of ocul
ar and CNS herpesvirus infection.
Conclusion: Herpesvirus infection of eye and brain was a frequent finding a
t necropsy in this group of HIV infected patients; almost a fifth were co-i
nfected by more than one herpesvirus. This was more than twice the incidenc
e predicted from clinical evidence before death. Genome detection using nPC
R was superior to histological methods for diagnosis of ocular and CNS herp