title: Clinical relevance of the plasma load of cytomegalovirus in patients infected with HIV--a survival analysis.
abstract: To investigate whether asymptomatic cytomegalovirus (CMV) viraemia impact the course of human immunodeficiency virus (HIV) infection, this study evaluated the effect of CMV replication on progression of newly-diagnosed HIV infected individuals towards AIDS events and death. In a 3-year prospective study on co-infected patients, clinical, immunological, and virological tests were performed in a national reference hospital quarterly. CMV viraemia was quantified by RoboGene® HCMV DNA Quantification Kit (Analytik Jena, Germany), on ABI Prism® 7000 Sequence Detection System (Applied Biosystems, USA). One hundred and five patients were enrolled with a balanced sex distribution and a median age of 30.7 years. Median CD4(+) cell count at enrollment was 164/mm(3) and median HIV RNA 4.6 log10 copies/ml. Detectable CMV viraemia was found in 25.7% of the patients. Kaplan-Meier analysis showed progression of HIV infection to be significantly increased in those with active CMV replication and/or low CD4(+) cell count. Cox regression indicated the risk of developing new AIDS events was 2.6 times greater in patients with detectable CMV viraemia versus those without (CI95% 1-6.6; P = 0.04). Also in multivariate analysis, the overall risk of progression to AIDS events or death was 3-fold higher in those with detectable CMV viraemia (CI95% 1.3-6.7; P = 0.008) and 2.3-fold higher if CD4(+) cell count was below 100/mm(3) (CI95% 1-5.1; P = 0.04). In these young Romanian HIV-seropositives, active CMV replication increased morbidity, even when treated with combination antiretroviral therapy. Further studies are needed to evaluate if serial quantitative CMV-DNA levels might correlate with non-infectious inflammation-related risks in patients with HIV and active CMV infection.
authors.affiliation: University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania; Prof. Dr. Matei Balş National Institute of Infectious Diseases, Bucharest, Romania.
authors.forename: Victoria
authors.initials: V
authors.lastname: Aramă
authors.forename: Raluca
authors.initials: R
authors.lastname: Mihăilescu
authors.forename: Mihaela
authors.initials: M
authors.lastname: Rădulescu
authors.forename: Sorin Ştefan
authors.initials: SŞ
authors.lastname: Aramă
authors.forename: Adrian
authors.initials: A
authors.lastname: Streinu-Cercel
authors.forename: Mike
authors.initials: M
authors.lastname: Youle
mesh_terms: D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000821:virology*; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D010949:Plasma / Q000821:virology*; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D019562:Viral Load; D055815:Young Adult
keywords: AIDS events; CMV viraemia; co-infection with HIV and CMV