title: Physical function impairment of older, HIV-infected adults is associated with cytomegalovirus immunoglobulin response.
abstract: Cytomegalovirus (CMV) is associated with poor outcomes, including physical function impairment, in older HIV-uninfected adults. Whether CMV is associated with physical functional impairment in HIV-infected adults is unknown. The primary objective of this study was to determine the relationship between CMV-specific humoral and cell-mediated immune responses with functional impairment in well-controlled HIV infection. In a case-control study, low-function cases were matched by age, gender, and time from HIV diagnosis to high-function controls. Quantitative CMV IgG and %CMV-specific CD8(+) and CD4(+) T cells (interferon-γ expression following CMV pp65 stimulation) were used to estimate physical function. Among 30 low-function cases and 48 high-function matched controls, CMV IgG ranged from <10 to 8,830 EU/ml, including four controls with results <10 EU/ml. Each log10 increase in CMV IgG was associated with 5-fold greater odds of low function (p=0.01); these findings were robust to adjustment for concomitant CD4(+) count, tobacco use, and age; to exclusion of subjects with CMV IgG <10 EU/ml; and to adjustment for hepatitis C viremia. %CMV-specific CD4(+) or CD8(+) T cells were not associated with low function. In bivariable models, the relationship between CMV IgG and physical function was attenuated and was no longer significant when including IL-6, CD4/CD8 ratio, or the Veterans Aging Cohort Study Index score. High levels of CMV-specific IgG were associated with impaired physical function. Attenuation of the strength of this association in bivariable models suggests an indirect relationship mediated by systemic inflammation and immune suppression.
authors.affiliation: 1 Department of Medicine, University of Colorado , Aurora, Colorado.
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Erlandson
authors.affiliation: 2 Colorado School of Public Health , Aurora, Colorado.
authors.forename: Amanda A
authors.initials: AA
authors.lastname: Allshouse
authors.affiliation: 1 Department of Medicine, University of Colorado , Aurora, Colorado.
authors.forename: Eric
authors.initials: E
authors.lastname: Rapaport
authors.affiliation: 1 Department of Medicine, University of Colorado , Aurora, Colorado.
authors.forename: Brent E
authors.initials: BE
authors.lastname: Palmer
authors.affiliation: 1 Department of Medicine, University of Colorado , Aurora, Colorado.
authors.forename: Cara C
authors.initials: CC
authors.lastname: Wilson
authors.affiliation: 1 Department of Medicine, University of Colorado , Aurora, Colorado.|3 Department of Pediatrics, University of Colorado , Aurora, Colorado.|4 Department of Pathology, University of Colorado , Aurora, Colorado.
authors.forename: Adriana
authors.initials: A
authors.lastname: Weinberg
authors.affiliation: 2 Colorado School of Public Health , Aurora, Colorado.
authors.forename: Samantha
authors.initials: S
authors.lastname: MaWhinney
authors.affiliation: 1 Department of Medicine, University of Colorado , Aurora, Colorado.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Campbell
mesh_terms: D000914:Antibodies, Viral / Q000276:immunology*; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D016022:Case-Control Studies; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000276:immunology / Q000503:physiopathology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000503:physiopathology*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010809:Physical Fitness
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G