title: Association of CMV-Specific T Cell-Mediated Immunity with CMV DNAemia and Development of CMV Disease in HIV-1-Infected Individuals.
abstract: BACKGROUND
  Among HIV-1-infected individuals, cytomegalovirus (CMV) reactivation and disease occur in the setting of advanced immunosuppression. The value of a standardized assessment of CMV-specific T-cell mediated immunity by the CMV QuantiFERON assay (CMV-QFT) has not yet been thoroughly investigated in HIV-1-infected subjects.
  
  
  METHODS
  Prospective, longitudinal study in 153 HIV-1-infected subjects with a CD4+ T cell count < 350/μL who simultaneously underwent CMV-QFT, CMV serology testing and CMV-DNA quantification. Factors associated with CMV-QFT were evaluated. Clinical screening for CMV manifestations was then performed every 3 months.
  
  
  RESULTS
  Among the 141 CMV IgG-seropositive individuals the CMV-QFT assay yielded reactive results in 84% (118/141), negative results in 15% (21/141) and indeterminate (negative mitogen IFN-gamma response) results in 1% (2/141) of subjects. The mean actual CD4+ T cell count was significantly higher in CMV-QFT reactive subjects, when compared to CMV-QFT non-reactive individuals (183 ± 102 vs. 126 ± 104 cells/μL, P = 0.015). A significantly lower proportion of CMV-QFT reactive vs. non-reactive patients displayed CMV DNAemia > 100 copies/mL (23% (27/118) vs. 48% (11/23), P = 0.02). Furthermore, a statistically significant inverse association between mitogen IFN-gamma response and CMV-DNAemia > 1000 copies/mL was observed (P < 0.001). During the observational period, 5 CMV end-organ manifestations were observed. In three of the CMV cases the CMV-QFT yielded indeterminate results.
  
  
  CONCLUSIONS
  While CMV-QFT reactivity indicates CMV-specific immunity, indeterminate results due to negative mitogen IFN-gamma response might reflect HIV-1-induced immunodeficiency. Thus, dependency upon CD4+ T cell count should be considered when interpreting CMV-QFT results.
authors: Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases (DIAID), Medical University of Vienna, Vienna, Austria.
authors: Maximilian C
authors: MC
authors: Aichelburg
authors: Department of Virology, Medical University of Vienna, Vienna, Austria.
authors: Lukas
authors: L
authors: Weseslindtner
authors: Department of Internal Medicine III, Division of Gastroenterology & Hepatology, HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria.
authors: Mattias
authors: M
authors: Mandorfer
authors: Department of Laboratory Medicine, Division of Clinical Virology, Medical University of Vienna, Vienna, Austria.
authors: Robert
authors: R
authors: Strassl
authors: Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases (DIAID), Medical University of Vienna, Vienna, Austria.
authors: Armin
authors: A
authors: Rieger
authors: Department of Internal Medicine III, Division of Gastroenterology & Hepatology, HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria.
authors: Thomas
authors: T
authors: Reiberger
authors: Department of Virology, Medical University of Vienna, Vienna, Austria.
authors: Elisabeth
authors: E
authors: Puchhammer-Stöckl
authors: Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases (DIAID), Medical University of Vienna, Vienna, Austria.
authors: Katharina
authors: K
authors: Grabmeier-Pfistershammer
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count / Q000379:methods; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000276:immunology; D004279:DNA, Viral / Q000276:immunology; D005260:Female; D015658:HIV Infections / Q000276:immunology*; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D007371:Interferon-gamma / Q000276:immunology; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies
chemical_list: D004279:DNA, Viral; D007371:Interferon-gamma