Herpes simplex virus infections of the central nervous system in human immunodeficiency virus-infected patients: clinical management by polymerase chain reaction assay of cerebrospinal fluid

Clin Infect Dis. 1998 Aug;27(2):303-9. doi: 10.1086/514657.


A duplex polymerase chain reaction (PCR) assay for DNA from herpes simplex virus types 1 (HSV-1) and 2 (HSV-2) was applied to cerebrospinal fluid (CSF) from 918 human immunodeficiency virus (HIV)-infected patients with neurological symptoms. HSV-1 or HSV-2 (HSV-1/2) DNA was found in 19 patients (2%). For the 258 patients for whom a diagnosis was confirmed at autopsy, the sensitivity and specificity of PCR analysis for the diagnosis of HSV-1/2 encephalitis were 100% and 99.6%, respectively. Three patients with CD4+ cell counts of > or = 170/microL had HSV-1 central nervous system (CNS) infections (two) or HSV-2 meningitis (one). Sixteen patients with CD4+ cell counts of < 40/microL had HSV-1 CNS infections (two) or mixed HSV-1/2 and cytomegalovirus encephalitis (14). The response to antiviral treatment, which was assessed clinically and by CSF PCR analysis, was variable in the patients with the highest CD4+ cell counts and poor in those with more severe immunosuppression. CSF PCR analysis is of value for the diagnosis and follow-up of treatment of HSV-1/2 CNS infections in HIV-infected patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / cerebrospinal fluid
  • AIDS-Related Opportunistic Infections / diagnosis
  • AIDS-Related Opportunistic Infections / virology
  • Central Nervous System Infections / cerebrospinal fluid
  • Central Nervous System Infections / complications*
  • Central Nervous System Infections / diagnosis
  • DNA, Viral / cerebrospinal fluid*
  • HIV Infections / cerebrospinal fluid
  • HIV Infections / complications*
  • Herpes Simplex / cerebrospinal fluid
  • Herpes Simplex / complications*
  • Herpes Simplex / diagnosis
  • Humans
  • Polymerase Chain Reaction
  • Sensitivity and Specificity
  • Simplexvirus / genetics*


  • DNA, Viral