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Cytomegalovirus and HIV — More Than Meets the Eye

August 12, 2014

Cytomegalovirus and HIV — More Than Meets the Eye

  1. Charles B. Hicks, MD

Although CMV end-organ disease in HIV-infected individuals occurs much less often than before, CMV seropositivity may still be associated with adverse outcomes.

  1. Charles B. Hicks, MD

Cytomegalovirus (CMV) end-organ disease — especially sight-threatening CMV retinitis — was once a devastating AIDS-defining condition. Improved immune function in HIV-infected persons on antiretroviral treatment has greatly diminished the incidence of CMV opportunistic infection. However, data from a large Italian observational cohort of HIV-infected persons (ICONA) suggest that CMV may still contribute to adverse outcomes in HIV-infected persons.

Compared with the 992 ICONA participants who were seronegative for CMV at baseline, the 5119 who were CMV seropositive had a significantly increased frequency of serious non-AIDS events/deaths (adjusted hazard ratio 1.53; 95% confidence interval, 1.08–2.16). In this cohort, CMV seropositivity appeared to be an independent risk factor for cerebral/cardiovascular events. It did not have a significant effect on progression to an AIDS-defining event.

Comment

CMV infection is extremely common in HIV-infected individuals: Of 6111 ICONA participants with available CMV test results, 83.3% were seropositive. Although there was no apparent effect of CMV on progression to AIDS in the cohort, there was a significant increase in serious non-AIDS events/deaths. Mechanisms by which this could occur are unclear, but CMV has been associated with increased rates of cardiovascular disease and mortality in HIV-uninfected populations, perhaps by contributing to inflammation in atherosclerotic plaques. CMV-specific inflammatory responses may also play a role in immunosenescence. The authors suggest that these findings should prompt consideration of CMV seropositivity as a negative prognostic factor in HIV-infected patients — and consideration of closer monitoring for cerebral and cardiovascular disease.

  • Disclosures for Charles B. Hicks, MD at time of publication Consultant / Advisory board Bristol-Meyers Squibb; Gilead Sciences; Janssen Virology; ViiV; Merck Editorial boards UpToDate

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