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)

Abstract

We undertook a prospective study to analyze cytomegalovirus (CMV) end-organ disease (EOD) in subjects with advanced human immunodeficiency virus (HIV) infection. Of 403 individuals without prior CMV EOD who were followed up for a median of 151 weeks, 56 died and 21 developed CMV EOD. Twenty of the subjects with CMV EOD had CD4 cell counts of < or =50 cells/mm3 and HIV RNA level of >10,000 copies/mL of plasma at baseline; in these 20 subjects, an increase of CMV DNA level to greater than the quantification limits was associated with CMV EOD. A CD4 cell count of < or =100 cells/mm3 and an HIV RNA level of >10,000 copies/mL of plasma at baseline, a CMV DNA level of >200 copies/mL of blood during follow-up, or development of CMV EOD were all associated with decreased survival. HIV-infected subjects with CD4 cell counts of < or =50 cells/mm3 and HIV RNA levels of >10,000 copies/mL of plasma should have blood fractions screened for CMV DNA; if CMV DNA is detected, CMV prophylaxis might be considered.

Programmed Death 1 Expression on HIV-Specific CD4+ T Cells Is Driven by Viral Replication and Associated with T Cell Dysfunction

“…HIV-specific CD4 ϩ T cells that produced IL-2 did have levels of PD-1 similar to those of IFN-␥-producing CMV-specific CD4 ϩ T cells, suggesting that even the less mature IL-2-producing HIV-specific CD4 ϩ T cells are somewhat impaired. In addition, we did see higher expression of PD-1 on CMV-specific CD4 ϩ T cells in HIV-infected subjects than in HIV-seronegative subjects, which may reflect the higher level of CMV reactivation documented in subjects with active HIV disease (30,31).…”

Clinical Significance of Low Cytomegalovirus DNA Levels in Human Plasma

“…For HIV-positive patients with low CD4 counts, Erice et al studied the use of a CMV antigen assay (limit of detection reported as 200 copies/ml) and the reference protocol used in our study (11). In univariate analysis after adjustment for HIV load and CD4 count, an increase in the CMV copy number to Ͼ200/ml during the study was significantly associated with decreased survival.…”

“…Initial reports have demonstrated a broad linear range and a lower limit of detection below that of the COBAS CMV Monitor assay (4). While copy numbers of CMV DNA as low as those detected with the artus assay have been reported, the clinical significance of these "low-positive" levels in a population of immune-suppressed patients has not been well described (3,11,15).…”

Pacientes con infección por VIH/SIDA en una Unidad de Pacientes Críticos: La experiencia de un hospital general en un país en desarrollo

“…Este patrón es concordante con lo descrito previamente 11 . Aunque infrecuente, la neumonía por CMV ha sido reportada en pacientes con infección por VIH/SIDA y asociada como en este caso a un mal pronóstico 15 . Las infecciones mixtas, siempre con un compromiso pulmonar asociado y las neurológicas, ocuparon un papel importante dentro de las infecciones.…”