The significance of reactivation of latent herpes simplex viruses type 1 and 2 in the etiopathogenesis of chronic inflammatory eye diseases and the development of late post-uveal complications

Herpes simplex viruses type 1 and 2 (HSV-1 and HSV-2) cause widespread lifelong infections. These characteristics of herpes simplex virus infections (HSVI) are associated with the presence of two phases in the infectious cycle: the lytic infection phase, which involves the formation of new viral particles, and the latent infection phase, during which the HSV remains in cells in a hidden form that is less accessible to the immune system. The lytic and latent phases of HSVI differ in the form of the viral genome, its localization, number of active viral genes, and expressed viral products. Lytic infection primarily occurs in epithelial cells, while the reservoir of latent virus is the nuclei of sensory neurons of the ganglia innervating the site of lytic infection. “Abortive” infection of Hela transfected cells is considered as experimental analogue of latent neuron infection, in which HSV-1 genomes were detected in the nuclei of surviving cells for up to 5 weeks, retaining the ability to reactivate and induce lytic infection. Frequent subclinical reactivation of HSV with the release of infectious virus has been identified in individuals who have had herpes infections and in healthy people with chronic HSVI. Relapses of herpes disease occur much less frequently. Intercurrent diseases are one of the leading factors in the reactivation of latent HSV. Reactivation of HSV can trigger the exacerbation or development of non-herpetic diseases, complicating their course. Inclusion of specific antiviral agents in the complex therapy of such patients shortened the time till remission onset. HSV reactivation is a prognostically unfavorable factor not only in active eye disease but also in clinical remission. According to our data, subclinical HSV reactivation in patients with remission of uveitis increased the systemic production of pro-inflammatory and angiogenic chemokines, thus contributing to the chronicization of a low-grade inflammatory process and the development of late post-uveal complications. The question of prescribing specific antiviral therapy to such patients remains relevant.

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