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Cytomegalovirus (CMV) end-organ disease — especially sight-threatening CMV retinitis — was once a devastating AIDS-defining condition. Improved immune function in HIV-infected persons on antiretroviral treatment has greatly diminished the incidence of CMV opportunistic infection. However, data from a large Italian observational cohort of HIV-infected persons (ICONA) suggest that CMV may still contribute to adverse outcomes in HIV-infected persons.
Compared with the 992 ICONA participants who were seronegative for CMV at baseline, the 5119 who were CMV seropositive had a significantly increased frequency of serious non-AIDS events/deaths (adjusted hazard ratio 1.53; 95% confidence interval, 1.08–2.16). In this cohort, CMV seropositivity appeared to be an independent risk factor for cerebral/cardiovascular events. It did not have a significant effect on progression to an AIDS-defining event.
Lichtner M et al. CMV co-infection is associated with increased risk of severe non-AIDS events in a large cohort of HIV-infected patients. J Infect Dis 2014 Jul 31; [e-pub ahead of print]. (http://dx.doi.org/10.1093/infdis/jiu417)
Comment
CMV infection is extremely common in HIV-infected individuals: Of 6111 ICONA participants with available CMV test results, 83.3% were seropositive. Although there was no apparent effect of CMV on progression to AIDS in the cohort, there was a significant increase in serious non-AIDS events/deaths. Mechanisms by which this could occur are unclear, but CMV has been associated with increased rates of cardiovascular disease and mortality in HIV-uninfected populations, perhaps by contributing to inflammation in atherosclerotic plaques. CMV-specific inflammatory responses may also play a role in immunosenescence. The authors suggest that these findings should prompt consideration of CMV seropositivity as a negative prognostic factor in HIV-infected patients — and consideration of closer monitoring for cerebral and cardiovascular disease.