In an article published electronically prior to its appearance in the 15 August 2003 issue of Clinical Infectious Diseases, investigators from the US AIDS Clinical Trials Group report that despite HAART, the cumulative incidence of CMV disease after almost three years of follow-up was 6%, higher than the 3.2% to 5% per year seen in other post-HAART studies. Those with 3 and an HIV viral load >10,000 copies/mL of plasma were at greatest risk, and the risk was further increased when CMV DNA was detected in blood or plasma.
Cytomegalovirus (CMV) infection is an extremely common HIV co-infection, and prior to 1997, the incidence of CMV end-organ disease (EOD) was >20% per year in people with a CD4 cell count of 3.
Between August and December 1997, 403 people with CD4 cell counts of less than 50 cells/mm3 within the 24 months prior to study entry who had not previously been diagnosed with CMV disease were enrolled in the study and followed for a median of 2.9 years.
Twenty-one patients developed CMV EOD during the study; all had >10,000 copies/mL of plasma at baseline, and all but one had CD4 cell counts 3. The majority of study participants with 3 and >10,000 HIV RNA copies/mL did not develop CMV EOD, however. The authors note that the risk was the same in those who were receiving and not receiving HAART, indicating “that even in the era of potent antiretroviral therapies, individuals with advanced HIV infection remain at high risk for developing CMV EOD.”
The investigators found that baseline CMV DNA levels were not significantly associated with the development of CMV EOD; however, an increase in the CMV DNA level to >200 copies/mL of blood or >400 copies/mL of plasma during follow-up was a significant risk factor for the development of CMV EOD (P = .03). This usually manifested itself in the eyes (n=17), but also the colon (n=2), lungs (n=1) and oesophagus (n=1).
The authors conclude that “screening for CMV DNA in blood fractions should be considered for subjects who have 3 and >10,000 HIV RNA copies/mL of plasma.” Studies are currently underway to determine whether starting CMV prophylaxis increases survival in those at risk.
Further information on this website
CMV-related vision loss still common in HAART era - news story
CMV viral load remains useful predictor of HIV disease risk - news story
Screening for CMV advisable when HAART fails - news story
Erice A et al. 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) Clinical Infectious Diseases 2003;37:000 Electronically Published July 28 2003