Assessment of the efficacy and safety of pre-emptive anti-cytomegalovirus (CMV) therapy in HIV-infected patients with CMV viraemia.
A number of studies have demonstrated that cytomegalovirus (CMV) viraemia is a strong predictor for CMV end-organ disease (EOD) and death in HIV-infected patients. We assess the efficacy and safety of pre-emptive anti-CMV therapy (PACT) for preventing these events. We performed a retrospective study of all HIV-infected patients seen in our institution who had detectable CMV viraemia in 2007. Seventy-one patients with advanced HIV disease (median CD4 cell count = 61 cells/mm(3)) were studied. Sixteen patients received PACT (mainly valganciclovir). Patients who received PACT had lower CD4 cell counts and higher blood CMV DNA levels. The cumulative incidence of CMV EOD and death at one year was 44% and 21% in patients with and without PACT, respectively (p = 0.013). Both PACT and high blood CMV DNA levels were significantly associated with CMV EOD and death in unadjusted analysis. In adjusted analyses, only blood CMV DNA levels remained significantly associated with the risk of CMV EOD and death, whereas PACT was associated with a non-significant trend towards reduced CMV EOD or death (hazard ratio: 0.25, p = 0.13). Five patients with PACT experienced severe drug-related adverse events. In conclusion, the use of PACT in HIV-infected patients with CMV viraemia could improve outcome but is associated with significant toxicity.
Department of Infectious Diseases, Saint-Louis Hospital, Paris, France mattionis@yahoo.fr.
Sarah
S
Mattioni
Department of Infectious Diseases, Saint-Louis Hospital, Paris, France.
Juliette
J
Pavie
Department of Biostatistics, Saint-Louis Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP), and University of Paris 7, Sorbonne Paris Cité, Paris, France.
Raphaël
R
Porcher
Laboratory of Virology, Saint-Louis Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP), and University of Paris 7, Sorbonne Paris Cité, France.
Catherine
C
Scieux
Department of Infectious Diseases, Saint-Louis Hospital, Paris, France.
Blandine
B
Denis
Department of Infectious Diseases, Saint-Louis Hospital, Paris, France.
Nathalie
N
De Castro
Laboratory of Virology, Saint-Louis Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP), and University of Paris 7, Sorbonne Paris Cité, France.
François
F
Simon
Department of Infectious Diseases, Saint-Louis Hospital, Paris, France.
Jean-Michel
JM
Molina
D017088:AIDS-Related Opportunistic Infections / Q000401:mortality / Q000517:prevention & control*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000097:blood / Q000401:mortality / Q000517:prevention & control*; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D016896:Treatment Outcome; D000077562:Valganciclovir; D019562:Viral Load; D014766:Viremia / Q000453:epidemiology / Q000517:prevention & control*
D019380:Anti-HIV Agents; D000998:Antiviral Agents; D004279:DNA, Viral; D000077562:Valganciclovir; D015774:Ganciclovir
AIDS; CMV; Cytomegalovirus; HIV; opportunistic infection; pre-emptive treatment; toxicity; valganciclovir