title: Cytomegalovirus coinfection is associated with an increased risk of severe non-AIDS-defining events in a large cohort of HIV-infected patients.
abstract: BACKGROUND
  Chronic cytomegalovirus (CMV) infection has been associated with immunosenescence and immunoactivation in the general population. In human immunodeficiency virus type 1 (HIV-1)-infected people, CMV coinfection, in addition to residual HIV replication and microbial translocation, has been proposed as a key factor in sustaining immune activation, even in individuals with a controlled HIV load.
  
  
  METHODS
  Patients from the ICONA Study with at least 1 CMV immunoglobulin G (IgG) test available without active CMV disease were included in the analysis. AIDS-defining event or AIDS-related death and severe non-AIDS-defining event or non-AIDS-related death were taken as clinical progression end points. Independent predictors of CMV were identified by multivariable logistic regression. Probabilities of reaching the end points were estimated by survival analyses.
  
  
  RESULTS
  A total of 6111 subjects were included, of whom 5119 (83.3%) were CMV IgG positive at baseline. Patients with CMV IgG positivity at baseline were more likely to develop a severe non-AIDS-defining event/non-AIDS-related death (adjusted hazard ratio [HR], 1.53 [95% confidence interval {CI}, 1.08-2.16]. In particular, CMV seropositivity was an independent risk factor for cardiovascular and cerebrovascular diseases (adjusted HR, 2.27 [95% CI, .97-5.32]).
  
  
  CONCLUSIONS
  In our study population, CMV/HIV coinfection was associated with the risk of severe non-AIDS-defining events/non-AIDS-related death, especially with cardiovascular and cerebrovascular events, independently of other prognostic factors. This finding supports a potential independent role of CMV coinfection in vascular/degenerative organ disorders in HIV-infected subjects.
authors.affiliation: Sapienza University of Rome, Polo Pontino, Latina.
authors.forename: Miriam
authors.initials: M
authors.lastname: Lichtner
authors.affiliation: San Paolo Hospital.
authors.forename: Paola
authors.initials: P
authors.lastname: Cicconi
authors.affiliation: Cenci Bolognetti Foundation.
authors.forename: Serena
authors.initials: S
authors.lastname: Vita
authors.affiliation: UCL Medical School, London, United Kingdom.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cozzi-Lepri
authors.affiliation: Sacco Hospital.
authors.forename: Massimo
authors.initials: M
authors.lastname: Galli
authors.affiliation: Santa Maria Annunziata Hospital, Florence.
authors.forename: Sergio
authors.initials: S
authors.lastname: Lo Caputo
authors.affiliation: Bari University.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Saracino
authors.affiliation: Siena University Hospital.
authors.forename: Andrea
authors.initials: A
authors.lastname: De Luca
authors.affiliation: Niguarda Ca' Grande Hospital, Milan.
authors.forename: Mariacristina
authors.initials: M
authors.lastname: Moioli
authors.affiliation: Ospedali Riuniti, Brescia, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Maggiolo
authors.affiliation: San Paolo Hospital.
authors.forename: Giulia
authors.initials: G
authors.lastname: Marchetti
authors.affiliation: Department of Public Health, Sapienza University of Rome.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Vullo
authors.affiliation: San Paolo Hospital.
authors.forename: Antonella
authors.initials: A
authors.lastname: d'Arminio Monforte
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002561:Cerebrovascular Disorders / Q000453:epidemiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003586:Cytomegalovirus Infections / Q000276:immunology*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G
keywords: CMV infection; HIV infection; cardiovascular/cerebrovascular events; morbidity; mortality; severe non–AIDS-defining events