Canadian Consensus Guidelines for the Management of Cytomegalovirus Disease in HIV/AIDS

Lalonde, Richard; Bovivin, Guy; Deschênes, Jean; Hodge, William; Hopkins, J Jill; Klein, Alex; Lindley, Janette; Phillips, Peter; Shafran, Stephen D.; Walmsley, Sharon

doi:10.1155/2004/369390

Cited by 9 publications

(6 citation statements)

References 59 publications

(65 reference statements)

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“…Thirdly, the delay for requesting CMV-Ag and the risk of severe disease severity and higher mortality rate. There are well-established recommendations for screening, treatment and prevention of CMV infection in immunocompromised patients with other conditions, such as cancer, AIDS and transplants [5,[7][8][9][10][11]20]. However, there are a lack of information about management of AIRD patients, highlighting the relevance of current study and supporting the necessity for the development of specific protocols in this scenario.…”

Section: Discussionmentioning

confidence: 99%

“…There are some epidemiological data and management guidance addressed to immunosuppressed patients, including AIDS and after solid organ and bone marrow transplantation [7][8][9][10][11]. However, there is a lack of evidence in patients with AIRD and the recommendations for managing these patients are extrapolated from transplantation data [12].…”

Section: Introductionmentioning

confidence: 99%

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Incidence of Cytomegalovirus Antigenemia in patients with autoimmune rheumatic diseases: a 3-year retrospective study

Santos

Reis-Neto

2019

Adv Rheumatol

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Objective: To determine the incidence of positive CMV antigenemia (CMV-Ag) in patients with autoimmune rheumatic diseases (AIRD) and to describe the outcomes of these patients. Methods: From January 2011 to December 2014, a total of 443 patients with AIRD were enrolled in this retrospective analysis. Demographic, clinical and laboratory data, current clinical manifestations, organs affected by CMV infection, therapeutic management and outcomes were evaluated. The CMV-Ag was considered positive when one cell was detected at least. Results: CMV-Ag was requested in 70 (15.8%) patients with suspicious CMV infection and was positive in 24 (34. 3%). The incidence rate of positive CMV-Ag was 4.97% (95% CI 3.1-7.4%). Systemic lupus erythematosus (SLE) (59%), followed by ANCA-related vasculitis (18.2%) and rheumatoid arthritis (9%) were the diseases more associated with positive CMV-Ag. At the time of CMV infection, SLE patients had moderate to severe disease activity, with high frequency of positive anti-dsDNA antibody (69.2%) and complement consumption (61.5%), as well as high doses of corticosteroids and use of immunosuppressants. The main CMV sites involved were lung (45.5%), bone marrow (40. 9%) and gut (27.3%). Mortality rate was 45.5%, especially in those with higher doses of daily oral corticosteroids (107 ± 55.4 mg vs. 71.7 ± 46.3 mg; p = 0.07) and lower number of lymphocytes (309 ± 368.2/mm 3 vs. 821 ± 692.9/ mm 3 ; p = 0.06). Conclusions: Our data showed high incidence of CMV-Ag in AIRD patients, particularly those with SLE and greater disease severity. In addition, it was observed high mortality in these patients, highlighting the CMV infection should be included in differential diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence of Cytomegalovirus Antigenemia in patients with autoimmune rheumatic diseases: a 3-year retrospective study

Santos

Reis-Neto

2019

Adv Rheumatol

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Section: Discussionmentioning

confidence: 99%

“…The main reason for the high recurrence rate of CMV infection after stopping therapy is that all anti-CMV drugs, including ganciclovir and valganciclovir, are virustatic and not virucidal. 21 In order to reduce the recurrence rate of CMV anterior segment inflammation after cessation of valganciclovir, other forms of ganciclovir treatment such as intravitreal or topical treatment have been suggested. 10 , 12 Chee and Jap evaluated the use of systemic, topical, and intravitreal ganciclovir in 72 eyes from 70 patients with CMV anterior uveitis and found that topical ganciclovir gel had a moderate response rate but a lower recurrence rate compared with systemic or intravitreal ganciclovir.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of oral valganciclovir for treatment of anterior segment inflammation secondary to cytomegalovirus infection

Wong

Chan²,

Leung³

et al. 2012

OPTH

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BackgroundThe purpose of this study was to assess the efficacy of oral valganciclovir in the treatment of anterior segment inflammation caused by cytomegalovirus (CMV) infection.MethodsConsecutive patients with anterior segment inflammation due to CMV causing anterior uveitis or corneal endotheliitis treated with oral valganciclovir were reviewed. Diagnosis of CMV infection was confirmed by polymerase chain reaction of the aqueous aspirate prior to commencement of oral valganciclovir. All patients were treated with an oral loading dose of 900 mg valganciclovir twice daily for at least 2 weeks, followed by an additional 450 mg valganciclovir twice-daily maintenance therapy. Changes in visual acuity, intraocular pressure (IOP), use of antiglaucomatous eye drops, and recurrence were analyzed.ResultsThirteen eyes of 11 patients were followed for a mean of 17.2 months. Two patients had bilateral corneal endotheliitis. All eyes had absence of anterior segment inflammation within 3 weeks after treatment. Following treatment, the mean logMAR visual acuity improved significantly from 0.58 at baseline to 0.37 at the last follow-up (P = 0.048). The mean IOP and number of antiglaucomatous eye drops also decreased significantly (P = 0.021 and P = 0.004, respectively). Five (38.5%) eyes had recurrence of anterior uveitis after valganciclovir was stopped and required retreatment with oral valganciclovir.ConclusionOral valganciclovir appeared to be effective in controlling CMV anterior uveitis, resulting in visual improvement and IOP reduction following control of inflammation. However, despite the initial clinical response in all cases, recurrence after cessation of oral valganciclovir could occur.

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“…1,3,4 O tratamento e a profilaxia da infeção por CMV em imunodeprimidos incluem ganciclovir (iv), valganciclovir (po), foscarnet (iv) ou cidofovir (iv). 1,5,6 Apresentamos o caso de uma doente com síndrome de imunodeficiência adquirida (SIDA), gravemente imunodeprimida, com ulcerações extensas provocadas por CMV. O exame da pele revelou lesões dispersas na face, membros e região glútea.…”

Section: Introductionunclassified

Infeção Cutânea por Citomegalovírus em Doente com Infecção VIH/SIDA

Banquimane

Gudo

Cunha

et al. 2016

SPDV

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RESUMO -A infecção por citomegalovírus tem distribuição mundial com alta prevalência nos países subdesenvolvidos, onde atinge quase 100% da população. As manifestações cutâneas são raras. A apresentação inespecífica das mesmas pode contribuir para o subdiagnóstico da doença. Relatamos o caso clínico de uma doente de 24 anos, gravemente imunodeprimida, com ulcerações na pele com quatro meses de evolução, e diagnóstico de infecção por vírus de imunodeficiência humana tipo 1 dois meses após o início das lesões. Na terceira semana de internamento desenvolveu uma retinite aguda por citomegalovírus e, embora tenha iniciado tratamento antirretrovírico e depois ganciclovir acabou por falecer após três meses por pericardite aguda. PALAVRAS-CHAVE -Dermatopatias Virais; Infecções por Citomegalovirus; Infecções por VIH; Infecções Oportunistas Relacionadas com a SIDA; Moçambique. Cutaneous infection with cytomegalovirus in patients with HIV / AIDS infection ABSTRACT -Infection by cytomegalovirus has worldwide distribution with high prevalence in developing countries, where it reaches almost 100% of the population. Cutaneous manifestations are rare. Moreover, unspecific presentation of dermatological lesions may contribute to subdiagnosis of the disease. We report a case of a 24 years-old female patient, severely immunocompromised, with ulcerations on the skin with 4 months of evolution, diagnosed with human immunodeficiency virus type 1 infection two months after the onset of lesions. In the third week of hospitalization she developed an acute cytomegalovirus retinitis, and despite initiation of anti-retroviral and anti-cytomegalovirus treatment initiation, she died after three months with an acute pericarditis. KEY-WORDS -AIDS-Related Opportunistic Infections; Cytomegalovirus Infections; HIV Infections; Mozambique; Skin Diseases, Viral.INTRODUÇÃO O citomegalovírus (CMV) é um vírus pertencente à famí-lia Herpesviradae, cuja patogénese, à semelhança de outros herpesvírus, obedece à sequência primo-infeção, latência e reactivação.1 A prevalência da infecção pelo CMV é variá-vel: cerca de 40% nos países desenvolvidos e quase 100% nos subdesenvolvidos.2 Pensa-se que a elevada prevalência nestes últimos países se deva, entre outros fatores, a más condições de higiene relacionados com grandes aglomerados populacionais onde coabitam, em pequenos espaços, numerosos adultos e crianças. 1A principal forma de transmissão do CMV é o contacto sexual embora, para além do esperma e secreções cervicovaginais, sejam também veículos de transmissão do vírus a Correspondência:

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Canadian Consensus Guidelines for the Management of Cytomegalovirus Disease in HIV/AIDS

Cited by 9 publications

References 59 publications

Incidence of Cytomegalovirus Antigenemia in patients with autoimmune rheumatic diseases: a 3-year retrospective study

Incidence of Cytomegalovirus Antigenemia in patients with autoimmune rheumatic diseases: a 3-year retrospective study

Long-term results of oral valganciclovir for treatment of anterior segment inflammation secondary to cytomegalovirus infection

Infeção Cutânea por Citomegalovírus em Doente com Infecção VIH/SIDA

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