AIDS-related cytomegalovirus encephalitis in the late ART era: A retrospective cohort study at a referral center in Brazil

Abstract

Background AIDS-related cytomegalovirus (CMV) encephalitis has declined in the combined antiretroviral therapy (ART) era in high-income countries. However, there is scarce information on CMV encephalitis in low- and middle-income countries. The objectives of this study were to identify the prevalence of AIDS-related CMV encephalitis and describe its main features. Methods This was a retrospective cohort study carried out at a referral center in São Paulo, Brazil. We included adult people living with HIV/AIDS (PLWHA), hospitalized in 2019, with a CD4 cell count ≤100/mm3 and quantitation CMV DNA results in plasma. Cases with compatible neurological manifestations and detection of CMV DNA by polymerase chain reaction (PCR) in cerebrospinal fluid samples were defined as CMV encephalitis. Results Among 761 PLWHA hospitalized, 248 (32.5%) cases were included in this study. Prevalence of CMV encephalitis was 2.4% (6/248) among all included cases and 7.7% (6/78) among individuals with neurological opportunistic diseases. The six patients with CMV encephalitis were males and had CD4 cell count <50/mm3. Five (83%) cases had CMV encephalitis as AIDS-defining disease and showed CMV DNA detection by PCR >500,000 UI/mL plasma. All six cases received anti-CMV therapy (ganciclovir, n = 4; ganciclovir plus foscarnet, n = 2) and five were discharged to home. CMV encephalitis was not uncommon among hospitalized PLWHA with neurological opportunistic diseases. Conclusions The epidemiological and immunological profile of individuals with CMV encephalitis was similar to that described in the pre-ART era, but in contrast, most cases were treated and discharged from the hospital.

AIDS-related gastrointestinal cytomegalovirus end-organ disease: A retrospective cohort study at a tertiary center in São Paulo, Brazil

“…Similar findings were observed in a prior study of CMV retinitis. 18 However, high values of quantitative detection of CMV-DNA in plasma (>50 000 IU/mL) were observed in the 2 patients of the present study with concomitant digestive system and neurological CMV-EOD, in CMV encephalitis cases, 27 and in CMV polyradiculopathy cases (J.E Vidal, personal communication). Therefore, it is possible that there is some relationship between the value of quantitative detection of CMV-DNA and the different clinical forms of CMV-EOD, particularly the neurological manifestations.…”

“…In a previous study conducted in our institution, intrahospital mortality in CMV encephalitis cases was 25%. 27 In the cART era, the mortality attributed to cytomegalic disease decreased by 37%. 31,32 In addition, the literature shows that the outcomes of patients with gastrointestinal CMV-EOD is better than those with central nervous system CMV-EOD.…”

Guillain-Barré Syndrome and Encephalitis Following a Cytomegalovirus Infection in an Immunocompetent Adult: A Case Report

“…Cytomegalovirus (CMV) is a widely prevalent herpesvirus, primarily known for causing asymptomatic or mild infections in immunocompetent adults [1,2]. However, in immunocompromised patients, such as those living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), undergoing organ transplantation, or receiving immunosuppressive therapy, CMV infection can lead to severe complications, including Guillain-Barré syndrome (GBS) and encephalitis [3,4].…”