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HSV-1 extremely common, with important clinical implications

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Herbert E. Kaufman, MD, said at The Royal Hawaiian Eye Meeting better antiviral drugs are needed to treat herpetic eye diseases.

WAIKOLOA, Hawaii — Herpes simplex virus-1 affects a large percentage of the population, a fact clinicians should bear in mind when considering surgery or the use of steroids in a patient, according to a speaker here.

During Hawaii 2005, The Royal Hawaiian Eye Meeting, Herbert E. Kaufman, MD, said there is a dire need for a better antiviral drugs to treat herpetic eye diseases such as necrotizing stromal disease or iritis more effectively. He said new antivirals, such as helicase-primase inhibitors, promise better ocular effectiveness but are still in the development phase.

Existing systemic drugs provide incomplete protection in that they diminish the frequency of recurrences by only about half, Dr. Kaufman said.

Dr. Kaufman and colleagues conducted a study to assess the prevalence of herpes simplex virus-1 in volunteers who had never exhibited herpes symptoms. They found that 98% of these asymptomatic subjects shed the virus in their tears or in their saliva at least once when tested twice daily during a 30-day period.

These findings have important implications for clinicians when it comes to treatments that involve the trauma of surgery or large doses of steroids, Dr. Kaufman said. The physician must question the patient about herpes history, he advised.

“Most herpes virus strands are quite benign and don’t do much unless your immune system is wiped out. It’s worth it to ask your patients if they have ever had labial herpes,” he said. “I have been helping doctors with malpractice cases who didn’t realize herpes was so common.”

Dr. Kaufman added that even recurrent conjunctivitis may be caused by herpes; giving large doses of steroids is not advisable in that situation.

By taking extra precautions and considering the possible presence of herpes in all patients, “maybe we can prevent the bad strands (of the virus) from wandering around the community and affecting others,” Dr. Kaufman said.