HIV-1 and HHV-6 antigens and transcripts in retinas of patients with AIDS in the absence of human cytomegalovirus

Purpose. The purpose of this study was to define the agents involved in the development of acquired immune deficiency syndrome (AIDS)-associated retinitis. To achieve this goal, the authors determined the frequency and proximity of the simultaneous presence of human immunodeficiency virus (HIV)- 1, human herpesvirus (HHV)-6, and human cytomegalovirus (HCMV) in retinas of patients with AIDS with and without AIDS-associated retinitis. Methods. Retinal sections from 50 globes from patients with AIDS were analyzed for the presence of viral antigens and transcripts. Group 1 contained 13 globes from patients with HCMV infection. Group 2 contained 20 globes from patients with retinal lesions of uncertain etiology in which HCMV antigen and transcripts were not detected. Group 3 contained 17 globes from patients with no retinal lesions. Results. Retinal sections from all 13 globes (group 1) were positive for HCMV antigens and HIV-1 antigens and transcripts. Six of the 13 retinas were also positive for HHV-6 antigens and transcripts. Sections from 13 of the 20 globes (group 2) were positive for HIV-1 antigens and transcripts, and 5 of these 13 were also positive for HHV-6 antigens and transcripts. Multiple areas in sections from two of the HIV-1-positive retinas showed coinfection with HHV-6. All 17 globes (group 3) were positive for HIV-1 antigens and transcripts. Ten of these 17 retinas were also positive for HHV-6 antigens. Human cytomegalovirus antigens were not detectable in retinas from groups 2 and 3. No viral antigens or transcripts were detectable in retinal sections from 10 HIV-1 negative donors. Conclusion. The coexistence of HIV-1 and HHV- 6 activity in more than 50% of retinas without HCMV infection suggests that HIV-1 and HHV-6 alone or in combination may predispose retinal tissue to other opportunistic agents such as HCMV during the development of AIDS- associated retinitis.