Background

Cytomegalovirus (CMV) end-organ disease (EOD) continues to pose a significant risk to patients with advanced HIV disease despite decreased incidence with combination anti-retroviral therapy (ART) and lower mortality with effective anti-CMV therapy. Subclinical CMV shedding may also contribute to ongoing inflammation and non-infectious comorbidities.

Methods

We examined the occurrence of CMV EOD and CMV shedding in a cohort of patients participating in a prospective observational study of severely immunosuppressed (CD4 ≤100 cells/μl), ART-naïve, HIV-1 infected adult participants.

Results

We studied 206 participants, of whom 193 (93.7%) were CMV IgG positive. Twenty-five participants (12.1%) developed confirmed CMV EOD. At baseline, 47 (22.8%) had CMV viremia detectable by PCR in the absence of clinical disease (CMV viremia). The remaining 134 (65%) had neither CMV EOD nor CMV viremia detected at baseline. Five participants with CMV EOD (2.4% of total cohort, 20% of CMV EOD) met AIDS Clinical Trials Group criteria for CMV immune reconstitution inflammatory syndrome (IRIS). Only one-third of CMV EOD patients had retinitis, while two-thirds presented with histologically confirmed gastrointestinal illness. CMV viremia was associated with higher percentages of activated CD8⁺ T cells even after HIV suppression.

Conclusion

The manifestations of CMV EOD in advanced HIV disease before and after initiation of ART may be more diverse than previously described, with high incidence of gastrointestinal illness. Recognition and treatment of unusual clinical presentations of CMV infection remains important in reducing morbidity and mortality from HIV co-infections.

中文翻译：

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联合抗逆转录病毒时代巨细胞病毒终末器官疾病胃肠道表现的高患病率

 背景

尽管联合抗逆转录病毒治疗 (ART) 降低了巨细胞病毒 (CMV) 终末器官疾病 (EOD) 的发病率，并且有效的抗CMV 治疗降低了死亡率，但巨细胞病毒 (CMV) 终末器官疾病 (EOD) 仍然对晚期 HIV 疾病患者构成重大风险。亚临床巨细胞病毒脱落也可能导致持续的炎症和非感染性合并症。

 方法

我们检查了参与一项前瞻性观察研究的一组患者中 CMV EOD 和 CMV 脱落的发生情况，该研究涉及严重免疫抑制（CD4 ≤ 100 个细胞/μl）、未接受 ART 的 HIV-1 感染成年参与者。

 结果

我们研究了 206 名参与者，其中 193 名 (93.7%) 为 CMV IgG 阳性。 25 名参与者 (12.1%) 确诊为 CMV EOD。在基线时，47 例 (22.8%) 在没有临床疾病（CMV 病毒血症）的情况下可通过 PCR 检测到 CMV 病毒血症。其余 134 名患者 (65%) 在基线时未检测到 CMV EOD 或 CMV 病毒血症。 5 名患有 CMV EOD 的参与者（占队列总数的 2.4%，CMV EOD 的 20%）符合艾滋病临床试验组关于 CMV 免疫重建炎症综合征 (IRIS) 的标准。只有三分之一的 CMV EOD 患者患有视网膜炎，而三分之二的患者则出现经组织学证实的胃肠道疾病。即使在 HIV 抑制后，CMV 病毒血症仍与较高百分比的活化 CD8 ⁺ T 细胞相关。

 结论

晚期HIV疾病在开始ART之前和之后CMV EOD的表现可能比之前描述的更加多样化，胃肠道疾病的发生率很高。识别和治疗 CMV 感染的异常临床表现对于降低 HIV 合并感染的发病率和死亡率仍然很重要。