Predictors of recurrent herpes simplex virus keratitis
Barron, BA; Edwards, K; Massare, SJ; McGovern, MS; Williams, D; Capps, SJ; Dragon, DM; Fitzmorris, CT; Graul, EE; Insler, MS; Kaufman, HE; Lacoste, AD; McCaa, CS; Selser, RE; Wagner, NJ; Yokubaitis, JA; Wilhelmus, KR; Todaro, LA; Woodside, SJ; Bowman, CB; Chodosh, J; Gilliam, RM; Goosey, JD; Jones, DB; Kirkland, C; Lehmann, RP; Matoba, AY; Pitts, RE; Scott, PD; Smith, SL; Wolf, TC; Yee, RW; Banuvar, S; Osaki, SY; Cohen, F; Barth, GP; Biswell, R; Cuningham, E; DeMartini, DR; Gritz, D; Hodge, W; Holsclaw, DS; Hwang, DG; Knox, CM; Lietman, T; Margolis, TP; Schwab, IR; Schwartz, L; Sherman, M; Silverstein, B; Vastine, DW; Volpicelli, M; Whitcher, JP; Wilson, S; Wong, IG; Stulting, RD; DuBois, LG; Baldassare, R; Bertram, BA; Chopra, H; Croll, SD; DiIorio, RC; Gussler, JR; Hamilton, SM; John, GR; McCann, JW; Meyer, JC; Mitchell, PG; Palay, DA; Ramirez, RJ; Reed, RE; Serros, RN; Taub, LR; Thompson, KP; Walter, KA; Sugar, J; Rodiek, R; Bouchard, CS; Dennis, R; Feder, RS; Hennessey, MJ; Lubeck, DM; McLeod, SD; Meisler, D; Morimoto, DD; Morimoto, PK; Rubenstein, JB; Tessler, HH; Hyndiuk, RA; Samson, C; Barney, NP; Brightbill, FS; DeCarlo, JD; Fogel, ES; Gainey, SP; Koenig, SB; Kontra, DJ; Krebs, DB; Lewellen, DR; Patalano, SM; Rice, PR; Sanderson, MC; Wienkers, KP; Yeomans, MM; Cohen, EJ; Marshall, SC; Rodriguez, IM; Phipps, P; Altman, AJ; Bailey, RJ; Fung, KL; Hannush, SB; Heffler, KF; Ingraham, HJ; Kesselring, JJ; Kowal, VO; Laibson, PR; Martin, NF; Naidoff, MA; Orlin, SE; Raber, IM; Rapuano, CR; Rubinfeld, RS; Sulewski, ME; Asbell, PA; Justin, N; Azueta, RC; Arroyo, M; Celanges, S; Annunziato, DM; Epstein, S; Barker, BA; Brocks, ER; Choo, NH; Constad, WH; D'Aversa, G; Dunn, MJ; Gorman, BD; Leopold, MR; Newton, MJ; Perez-Arroyo, VE; Schwartz, WJ; Sternberg, G; Udell, IJ; Beck, RW; Moke, PS; Blair, RC; Cole, SR; Gal, R; Gillespie, HA; Kip, K; Long, D; Lester, LA; Mhamdi, ML; Tan, ES; Hauck, WW; Gee, L; Hidayat, JE; Kurinij, N; Asbell, PA; Cohen, EJ; Dawson, CR; Hyndiuk, RA; Jones, DB; Kaufman, HE; Kurinij, N; Moke, PS; Stulting, RD; Sugar, J; Wilhelmus, KR; Bangdiwala, SI; Barlow, WE; Chandler, JW; Lempl, MA; Nesburn, AB; Patrick, DL; Sutphin, JE; Watson, SB; Herpetic Eye Dis Study Grp
Purpose. Determinants of the natural history of recurrent herpes simplex virus (HSV) keratitis have not been consistently established, We assessed how previous HSV eye disease affects the risk of recurrent HSV keratitis and evaluated whether demographic and other variables play any predictive role. Methods. Three hundred forty-six patients in the placebo group of the Herpetic Eye Disease Study's Acyclovir Prevention Trial who had experienced an episode of HSV eye disease in the previous year were followed up for 18 months. Recurrences were categorized according to the type of involvement. Relative rates of recurrence were compared for categories of demographic variables, types and number of previous ocular HSV episodes, previous nonocular HSV infection, and month of the year. Results. Fifty-eight (18%) of the 346 patients developed epithelial keratitis and 59 (18%) developed stromal keratitis during the 18 months of follow-up. Previous epithelial keratitis did not significantly affect the risk of epithelial keratitis (p = 0.84). In contrast, previous stromal keratitis increased the risk of stromal keratitis 10-fold (p < 0.001), and the risk was strongly related to the number of previous episodes (p < 0.001). Age, gender, ethnicity, and nonocular herpes were not significantly associated with recurrences, and no seasonal effects were observed. Conclusion. Among patients who experienced active ocular HSV disease in the previous year, a history of epithelial keratitis was not a risk factor for recurrent epithelial keratitis. In contrast, previous, especially multiple, episodes of stromal keratitis markedly increased the probability of subsequent stromal keratitis. $$:
ISI:000167178900001
ISSN: 0277-3740
CID: 107683
Psychological stress and other potential triggers for recurrences of herpes simplex virus eye infections
Cohen, F; Cole, SR; Beck, RW; Blair, RC; Moke, PS; Kip, KE; Wilhelmus, KR; Dawson, CR; Barron, BA; Jones, DB; Kaufman, HE; Stulting, RD; Sugar, J; Cohen, EJ; Hyndiuk, RA; Asbell, PA; Kurinij, N; Edwards, K; Massare, SJ; McGovern, MS; Williams, D; Dragon, DM; Graul, EE; Insler, MS; Kaufman, HE; Lacoste, AD; McCaa, CS; Wagner, NJ; Yokubaitis, JA; Wilhelmus, KR; Todaro, LA; Woodside, SJ; Bowman, CB; Chodosh, J; Goosey, JD; Jones, DB; Kirkland, C; Lehmann, RP; Matoba, AY; Smith, SL; Wolf, TC; Yee, RW; Cohen, F; Dawson, CR; Banuvar, S; Osaki, SY; Barth, GP; Biswell, R; Cunningham, E; DeMartini, DR; Gritz, D; Hodge, W; Holsclaw, DS; Hwang, DG; Knox, CM; Lietman, T; Margolis, TP; Schwab, IR; Schwartz, L; Sherman, M; Silverstein, B; Vastine, DW; Volpicelli, M; Whitcher, JP; Wilson, S; Wong, I; Stulting, RD; DuBois, LG; Baldassare, R; Chopra, H; Croll, SD; DiIorio, RC; Gussler, JR; Hamilton, SM; John, GR; McCann, JW; Meyer, JC; Mitchell, PG; Palay, DA; Ramirez, RJ; Reed, RE; Serros, RN; Taub, LR; Thompson, KP; Walter, KA; Sugar, J; Rodiek, R; Dennis, R; Feder, RS; Hennessey, MJ; Lubeck, DM; McLeod, SD; Meisler, D; Morimoto, DD; Morimoto, PK; Rubenstein, JB; Tessler, HH; Hyndiuk, RA; Samson, C; Barney, NP; Brightbill, FS; DeCarlo, JD; Fogel, ES; Gainey, SP; Koenig, SB; Kontra, DJ; Krebs, DB; Lewellen, DR; Patalano, SM; Rice, PR; Sanderson, MC; Wienkers, KP; Yeomans, MM; Cohen, EJ; Marshall, SC; Rodriguez, IM; Phipps, P; Bailey, RJ; Fung, KL; Hannush, SB; Ingraham, HI; Kesselring, JJ; Kowal, VO; Laibson, PR; Martin, NF; Orlin, SO; Rapuano, CR; Rubinefeld, RS; Sulewski, M; Asbell, PA; Justin, N; Arroyo, M; Epstein, S; Barker, BA; Brocks, RE; D'Aversa, G; Dunn, MJ; Gorman, BD; Leopold, MR; Schwartz, WJ; Udell, IJ; Beck, RW; Moke, PS; Blair, RC; Cole, SR; Kip, K; Gillespie, HA; Lester, LA; Mhamdi, ML; Gal, RL; Tan, ES; Hauck, WW; Gee, L; Bangdiwala, SI; Barlow, WE; Chandler, JW; Lemp, MA; Nesburn, AB; Patrick, DL; Sutphin, JE; Watson, SB; Herpetic Eye Dis Study Grp
Objective: To assess psychological stress and other factors as possible triggers of ocular herpes simplex virus (HSV) recurrences. Design: A prospective cohort study nested in a randomized, placebo-controlled, clinical trial. Setting: Fifty-eight community-based or university sites. Participants: Immunocompetent adults (N = 308), aged 18 years or older, with a documented history of ocular HSV disease in the prior year and observed for up to 15 months. Exposure Variables: Psychological stress, systemic infection, sunlight exposure, menstrual period, contact lens wear, and eye injury recorded on a weekly log. The exposure period was considered to be the week before symptomatic onset of a recurrence. Main Outcome Measure: The first documented recurrence of ocular HSV disease, with exclusion of cases in which the exposure week log was completed late after the onset of symptoms. Results: Thirty-three participants experienced a study outcome meeting these criteria. Higher levels of psychological stress were not associated with an increased risk of recurrence (rate ratio, 0.58; 95%;, confidence interval, 0.32-1.05; P=.07). No association was found between any of the other exposure variables and recurrence. When an analysis was performed including only the recurrences (n=26) for which the exposure week log was completed late and after symptom onset, there was a clear indication of retrospective overreporting of high stress (P =.03) and systemic infection (p=.01). Not excluding these cases could have produced incorrect conclusions due to recall bias. Conclusions: Psychological stress does not appear to be a trigger of recurrences of ocular HSV disease. If not accounted for, recall bias can substantially overestimate the importance of factors that do not have a causal association with HSV infection. $$:
ISI:000165738800001
ISSN: 0003-9950
CID: 107688