ReviewCytomegalovirus disease in the era of highly active antiretroviral therapy (HAART)
Section snippets
Changing epidemiology of CMV disease
Cytomegalovirus (CMV) infection was one of the most important opportunistic infections in HIV-infected patients before the introduction of HAART. Approximately 40% of HIV-infected patients with advanced disease suffered from one of several different manifestations of CMV disease during life-time (Bowen et al., 1996, Jabs et al., 1989, Pertel et al., 1992, Drew, 1992). Prophylaxis and treatment of other AIDS-related opportunistic infections had improved overall prognosis and extended
Is CMV still an issue?
Given this dramatic drop in incidence of CMV disease in HIV-infected patients, is it reasonable to worry about this infection anymore? Considering the evidence for a multitude of direct and indirect effects of CMV on HIV progression, the answer has to be yes. CMV-seropositive individuals progress 2.5 times more rapidly to AIDS and death than those who are CMV seronegative (Webster et al., 1989, Sabin et al., 2000, Sabin et al., 1995). In the case of primary CMV infection, even patients with
Virological diagnosis of disease
A large variety of laboratory techniques is available for the rapid and reliable diagnosis of CMV infection and disease. The individual assays have been reviewed in detail previously in this Journal (Grangeot-Keros and Cointe, 2001, Baldanti et al., 1998, de la Hoz et al., 2002). The focus of the following review will be on interpretation of test results, their predictive value for CMV disease, and guidance for the rational use of diagnostic assays in HIV-infected patients.
Clinical manifestations of CMV disease
Signs and symptoms are pathognomonic in a minority of manifestations of CMV disease. More commonly, clinical manifestations of CMV disease are too uncharacteristic to establish or refute the diagnosis of CMV disease. However, they may guide the rational use of virological assays and collection of clinical specimen.
Conclusions
Treatment of HIV-infected patients with HAART reduced dramatically the incidence of CMV disease, extended life expectancy and improved quality of life. Still, a considerable number of patients has CD4 cell counts below the critical threshold of 100 mm−3 and is therefore at high risk for CMV disease. All the more, early and reliable identification of patients at risk for and diagnosis of CMV disease remains critical in the management of HIV-infected patients. For this purpose, an integrated
References (97)
- et al.
Use of the human cytomegalovirus (HCMV) antigenemia assay for diagnosis and monitoring of HCMV infections and detection of antiviral drug resistance in the immunocompromised
J Clin Virol
(1998) Comparative analysis of sequence variation in gp116 and gp55 components of glycoprotein B of human cytomegalovirus
Virology
(1992)- et al.
Cytomegalovirus infection in homosexual men. Relationship to sexual practices, antibody to human immunodeficiency virus, and cell-mediated immunity
Am J Med
(1987) - et al.
Importance of cytomegalovirus viraemia in risk of disease progression and death in HIV-infected patients receiving highly active antiretroviral therapy
Lancet
(2004) - et al.
Hybridization techniques provide improved sensitivity for HCMV detection and allow quantitation of the virus in clinical samples
J Virol Methods
(1989) - et al.
Diagnosis and prognostic markers of HCMV infection
J Clin Virol
(2001) - et al.
AIDS across Europe, 1994–98: the EuroSIDA study
Lancet
(2000) - et al.
Cytomegalovirus encephalitis in patients with acquired immunodeficiency syndrome: an autopsy study of 30 cases and a review of the literature
Hum Pathol
(1987) - et al.
Glycoprotein B of human cytomegalovirus promotes virion penetration into cells, transmission of infection from cell to cell, and fusion of infected cells
Virology
(1993) - et al.
Immune recovery uveitis in patients with AIDS and cytomegalovirus retinitis after highly active antiretroviral therapy
Am J Ophthalmol
(2000)
Cytomegalovirus necrotizing bronchiolitis with HIV infection
Chest
Cytomegalovirus infection and progression towards AIDS in haemophiliacs with human immunodeficiency virus infection
Lancet
Pulmonary manifestations of HIV infection in the era of highly active antiretroviral therapy
Chest
Transient vitreous inflammatory reactions associated with combination antiretroviral therapy in patients with AIDS and cytomegalovirus retinitis
Am J Ophthalmol
Cytomegalovirus encephalitis
Ann Intern Med
Comparative evaluation of the cytomegalovirus DNA load in polymorphonuclear leukocytes and plasma of human immunodeficiency virus-infected subjects
J Infect Dis
Glycoprotein B genotype of human cytomegalovirus: distribution in HIV-infected patients
Scand J Infect Dis
Intrauterine transmission of cytomegalovirus to infants of women with preconceptional immunity
N Engl J Med
Lessons from the natural history of cytomegalovirus
AIDS
Cytomegalovirus (CMV) viraemia detected by polymerase chain reaction identifies a group of HIV-positive patients at high risk of CMV disease
AIDS
Oligomerization of the human cytomegalovirus major envelope glycoprotein complex gB (gp55-116)
J Virol
Isolation of viruses from stools in stem cell transplant recipients: a prospective surveillance study
Bone Marrow Transplant
Immunorestitution disease involving the innate and adaptive response
Clin Infect Dis
Usefulness of the cytomegalovirus (CMV) antigenemia assay for predicting the occurrence of CMV disease and death in patients with AIDS
Clin Infect Dis
Newer methods for diagnosis of cytomegalovirus infection
Rev Infect Dis
Diagnosis and clinical management of neurological disorders caused by cytomegalovirus in AIDS patients. European Union Concerted Action on Virus Meningitis and Encephalitis
J Neurovirol
Cytomegalovirus infection of the central nervous system in patients with AIDS: diagnosis by DNA amplification from cerebrospinal fluid
J Infect Dis
Oesophageal symptoms, their causes, treatment, and prognosis in patients with the acquired immunodeficiency syndrome
Gut
Clinical indicators of immune restoration following highly active antiretroviral therapy
Clin Infect Dis
Cytomegalovirus retinitis after immune reconstitution
AIDS Read
Diagnosis and treatment approaches of CMV infections in adult patients
J Clin Virol
Changing trends in cytomegalovirus disease in HIV-infected patients
Herpes
Changes in the natural history of cytomegalovirus retinitis following the introduction of highly active antiretroviral therapy
AIDS
Effectiveness of potent antiretroviral therapies on the incidence of opportunistic infections before and after AIDS diagnosis
AIDS
Development of cytomegalovirus (CMV) disease may be predicted in HIV-infected patients by CMV polymerase chain reaction and the antigenemia test
AIDS
Cytomegalovirus infection in patients with AIDS
Clin Infect Dis
Cytomegalovirus glycoprotein B groups in human immunodeficiency virus-infected patients with incident retinitis
J Infect Dis
Polymerase chain reaction detection of cytomegalovirus DNA in peripheral blood leukocytes as a predictor of cytomegalovirus disease in HIV-infected patients
AIDS
Cytomegalovirus (CMV) and human immunodeficiency virus (HIV) burden, CMV end-organ disease, and survival in subjects with advanced HIV infection (AIDS clinical trials group protocol 360)
Clin Infect Dis
Incidence and natural history of cytomegalovirus disease in patients with advanced human immunodeficiency virus disease treated with zidovudine. The Zidovudine Epidemiology Study Group
J Infect Dis
Cytomegalovirus (CMV) viremia and the CD4+ lymphocyte count as predictors of CMV disease in patients infected with human immunodeficiency virus
Clin Infect Dis
Comparative quantitation of human cytomegalovirus DNA in blood leukocytes and plasma of transplant and AIDS patients
J Clin Microbiol
Direct detection of cytomegalovirus from bronchoalveolar lavage samples by using a rapid in situ DNA hybridization assay
J Clin Microbiol
Rapid detection of cytomegalovirus DNA in cerebrospinal fluid of AIDS patients with neurologic disorders
J Infect Dis
Heterosexual and homosexual patients with the acquired immunodeficiency syndrome. A comparison of surveillance, interview, and laboratory data
Ann Intern Med
Variation within the glycoprotein B gene of human cytomegalovirus is due to homologous recombination
J Gen Virol
Survival of patients with AIDS and cytomegalovirus disease treated with ganciclovir or foscarnet
AIDS
Clinical manifestations of AIDS in the era of pneumocystis prophylaxis. Multicenter AIDS Cohort Study
N Engl J Med
Cited by (81)
Cytomegalovirus-associated esophageal stricture as a manifestation of the immune reconstitution inflammatory syndrome
2020, IDCasesCitation Excerpt :Gastrointestinal disease is the next most common manifestation of CMV disease and accounts for around 15 % of cases [3]. Pneumonitis and encephalitis represent less than 1% of all cases of CMV disease [3]. CMV can lead to disease throughout the gastrointestinal tract [3].
Novel trimeric human cytomegalovirus glycoprotein B elicits a high-titer neutralizing antibody response
2018, VaccineCitation Excerpt :Additional congenital sequelae include microcephaly, seizures, intracranial calcifications, cerebral palsy, hepatitis, and chorioretinitis resulting in vision loss [4–7]. In addition to congenital infections, HCMV produces significant clinical disease in the immunosuppressed, including transplant recipients and patients with AIDS [8–11]. Although HCMV infection in immunocompetent individuals is generally asymptomatic, it may produce a mononucleosis syndrome in 10% of primary infections of older children and adults [12].
AIDS-related cytomegalovirus encephalitis in the late ART era: A retrospective cohort study at a referral center in Brazil
2023, International Journal of STD and AIDS