Distribution and Determinants of Cytomegalovirus Induced End Organ Disease/s among People Living with HIV/AIDS in a Poor Resource Setting: Observation from India

Abstract

BackgroundIn India, despite well-established anti-retroviral treatment programs, Cytomegalovirus (CMV) infection-related end-organ diseases (EODs) still remain a major concern resulting in exacerbation of morbidity and mortality among HIV/AIDS patients. A prospective study was designed to understand the distribution and prognosis of CMV associated EODs and to determine a standardized cut-off value for serum CMV viral load associated with the development of EODs amongst HIV/AIDS subjects.MethodsIn a cohort of 400 late-diagnosed HAART naïve HIV/AIDS subjects attending anti-retroviral centers of Kolkata during 2008–2014, the median duration of follow-up was 560 days, and at least 3 visits subsequent to the baseline were mandatory for eligibility. HIV-1 and CMV viral load were estimated by performing Real-Time Polymerase Chain Reactions (PCR).ResultsAmong subjects, 40.5% (162/400) had CMV EODs which were more common at lower CD4 counts. Poor prognosis and higher death rate were associated with a low CD4 count and increased HIV-1 and CMV viral loads. Subjects having higher CD4 count responded better to therapy [for CD4 = 60–100: Risk Ratio:RR = 1.48 (95% Confidence Interval: 95%CI = 1.18–1.82) and for CD4 = 30–59: RR = 1.64 (95%CI = 1.18–2.27)]. The cut off value of the serum CMV viral load (expressed as log10DNA/ml serum) associated with the development of EODs and disseminated CMV EODs was determined as 5.4 (p<0.0001) and 6.4 (p<0.0001) respectively. These cut offs were found to have satisfactorily high sensitivity, specificity, positive and negative predictive values.ConclusionPrognosis of CMV EOD was poor as indicated by higher death rates among subjects with lower CD4 count, and specific cut-off values were found to have useful potential for identification and treatment of CMV infected HIV/AIDS patients in due time to avoid CMV EODs among HIV/AIDS subjects. Targeted intervention programs seemed to be required urgently to make these cut-offs operational in order to minimize the burden of CMV EOD in this vulnerable population.

Mismatched related vs matched unrelated donors in TCRαβ/CD19-depleted HSCT for primary immunodeficiencies

“…21 Similar observations regarding the prevalence of retinitis as the most common manifestation of CMV disease were reported in a large cohort of individuals with HIV-driven immune deficiencies. 22 Nevertheless, there are no protocols for CMV retinitis monitoring and management in HSCT recipients. In 1 of the first patients in our study (with WAS), CMV retinitis resulted in vision loss.…”

Routine Immediate Eye Examination at the Point of Care for Diagnosis of AIDS-Related Cytomegalovirus Retinitis Among Patients With a CD4 Count &lt;100 in Myanmar

“…CMVR is but 1 end-organ manifestation of CMV disease, a potentially fatal opportunistic infection [1, 4], with disseminated CMV infection being found at autopsy in up to half of patients who die of HIV/AIDS [5]. In resource-limited settings, a diagnosis of CMVR may be established on physical examination alone, whereas the diagnosis of other manifestations of CMV disease is difficult [1, 4]. Patients with CMVR have an all-cause mortality >25%, with most fatal outcomes in the first 3 months [6].…”

Multisystem cytomegalovirus end-organ disease in a patient with advanced HIV

“… 5 , 6 , 7 A larger cohort study of 400 people living with HIV and CD4 count < 100 cells/μL from India described a prevalence rate of 40.5%; only six patients had evidence of CMV EOD in more than two systems. 8 To our knowledge, simultaneous multisystem CMV EOD is uncommonly diagnosed in living patients. However, a review of an African autopsy series of people living with HIV and advanced immunosuppression identified CMV disease in 4.0% – 18.0% of cases, with multi-organ disease being common amongst these.…”