Effect of Immune-Modulatory Interventions on Asymptomatic Cytomegalovirus Shedding During Suppressive Antiretroviral Therapy

Hastie, Elizabeth; Moser, Carlee; Sun, Xin; Lennox, Jeffrey; Hsue, Priscilla Y.; Bosch, Ronald J.; Deeks, Steven G.; Meneses, Milenka V; Lederman, Michael M.; Hunt, P.; Henrich, Timothy J.; Marconi, Vincent C.; Gianella, Sara

doi:10.1093/infdis/jiad060

Cited by 2 publications

(1 citation statement)

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“…Most CMV end-organ disease occurs in PLWH with an absolute quantity of CD4+ T-cells (CD4+ count) <50 cells/mm 3 , in whom CMV viremia is a well-described risk factor [4][5][6]. Even in the absence of overt disease, CMV viremia is associated with mortality in PLWH, independent of CD4+ count and HIV plasma RNA quantity (HIV viral load) [7][8][9]. CMV infection has also been associated with an increased risk of cardiovascular disease and all-cause mortality [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Increased frequency and quantity of mucosal and plasma cytomegalovirus replication among Ugandan Adults Living with HIV

et al. 2023

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Background Co-infection with HIV can result in impaired control of cytomegalovirus (CMV) replication, increasing the likelihood of disease and onward transmission. The objective of this analysis was to measure the impact of HIV on CMV replication in an intensively-sampled cohort in Kampala, Uganda. Methods CMV seropositive men and women aged 18–65, with or without HIV co-infection, were followed for one month. Daily oral swabs and weekly anogenital swabs and plasma were collected. Quantitative CMV PCR was performed on all samples. Results Eighty-five participants were enrolled and provided ≥1 oral swab; 43 (51%) were HIV-seropositive. People living with HIV (PLWH; median CD4 count 439 cells/mm3; none on antiretrovirals) had 2–4 times greater risk of CMV detection at each anatomical site assessed. At the oral site, 773 of 1272 (61%) of samples from PLWH had CMV detected, compared to 214 of 1349 (16%) among people without HIV. Similarly, the mean CMV quantity was higher among PLWH at all anatomical sites, with the largest difference seen for oral swabs (mean difference 1.63 log/mL; 95% CI 1.13–2.13). Among PLWH, absolute quantity of CD4+ T-cells was not associated with risk of CMV detection. HIV plasma RNA quantity was positively correlated with oral CMV shedding frequency, but not detection at other sites. Conclusions Mucosal and systemic CMV replication occurs at higher levels in PLWH than people without HIV, particularly oral shedding, which is a major mode of CMV transmission. Increased CMV replication despite relatively preserved CD4+ T-cell counts suggests that additional interventions are required to improve CMV control in PLWH.

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