Background: Polyomavirus JCV and herpesvirus EBV are known to cause opportunistic diseases in untreated HIV-infected patients. However, little is known of the reactivation and shedding of these 2 common persistent viral infections in patients receiving HAART.

Methods: Blood, saliva, and urine were collected from 70 adult HIV-infected patients and 68 uninfected healthy volunteers. Inclusion criteria for HIV-infected adults included an HIV RNA viral load £1000; CD4 cell count between 200 and 700; on stable HAART regimen for at least 3 months; no anti-herpesvirus medications for at least 2 weeks; and no active opportunistic infection within the past 3 months. DNAs were extracted from the samples and polymerase chain reaction assays were carried out using virus-specific primers against polyomaviruses and EBV. Amplicons were confirmed by sequence analysis.

Results: JCV excretion in urine was elevated in HIV-positive patients compared to the HIV-negative group (22/70, 31% vs 13/68, 19%; p=0.09). JCV shedding displayed by uninfected individuals was age-related, with excretion most common by those ³40 years (4/44, 9% for <40 vs 9/25, 36% for ³40; p=0.005). This pattern of shedding was inverted in HIV-infected patients, with the younger group exhibiting higher rates of JCV excretion than the ³40 age group (12/29, 41% for <40 vs 10/41, 24% for ³40; p=0.12).  Similarly, EBV shedding in saliva was higher in the HIV-positive cohort than in the HIV-negative group (55/68, 80% vs 37/68, 54%; p=0.001). EBV was detected more frequently in blood from HIV-positive subjects than in the HIV-negative cohort (59/68, 87% vs 10/68, 15%; p=0.0001). In the HIV-positive group, JCV excretion in the urine was more frequent in subjects with CD4 cell counts of 200-500 cells/mm³ than in those with counts of 500-900 cells/mm³ (18/42, 43% vs 4/24, 17%; p=0.02). However, no significant difference between the 2 groups was observed for EBV shedding in saliva (34/42, 81% vs 17/24, 71%; p=0.3). In the HIV-negative group, no differences were observed in shedding of either JCV or EBV among individuals with CD4 cell counts of 500-900 cells/mm³ vs counts >900 cells/mm³, respectively (2/20, 10% vs 0/20, 0%; p=0.1 for JCV and 15/20, 75% vs 11/20, 55%; p=0.1 for EBV).

Conclusions: Even modest depressions in immune function may be associated with increased reactivation and shedding of JCV and EBV in HIV-infected patients on HAART.