Herpes Simplex Virus (HSV) Reactivation in COVID-19 Patients: A Mini Systematic Review

Abstract

Background and Aim: Herpes simplex viruses (HSV) occur worldwide and have a high prevalence. In the context of COVID -19 there are several potential triggers for HSV reactivation, such as functional depletion or imbalance of the immune system, use of immunosuppressive drugs to control cytokine response, and physical or psychological stress in consequence of the disease. The aim of this research is to review, by analysing the current scientific literature, the context of the HSV reactivation or infection in the context of the COVID-19 pandemic. Methods: A systematic review of scientific manuscripts was performed using the PubMed, SciELO, and Google Scholar databases. The evaluated manuscripts were published between 2019 and January 2023. Systematic studies of groups of patients with COVID-19 that evaluated the incidence of HSV reactivations and infections, as well as case reports of HSV reactivation in patients with SARS-CoV-2 infection, were analyzed. Results: Analysis of systematic studies among patients with COVID-19 revealed incidence rates of HSV reactivation detected by PCR technique, which can range from 12% to 83%. The incidence of clinical manifestations was heterogeneous, and the occurence of atypical clinical forms was considered high. HSV reactivations without clinical symptoms were observed in all studies in patients hospitalized with COVID -19. Determining the severity of infection and distinguishing between benign reactivation and true HSV infection concomitant with COVID-19 is a diagnostic challenge. Currently available scientific investigations are controversial regarding the impact on the prognosis of patients with human herpesvirus reactivation and the possible association between HSV infection and mortality rates. The broad spectrum of atypical forms, as well as difficulties in accurately diagnosing real HSV infection, may lead to underestimating the true impact of concurrent reactivation in COVID-19 patients. Patients receiving invasive mechanical ventilation and corticosteroid therapy are the groups at highest risk for HSV reactivation. Further investigations are needed to clarify the interaction between these two viruses in the context of SARS-CoV-2 disease and treatment.