Cytomegalovirus Infection in HIV Patients Ups Risk of Severe Non-AIDS Events

Cytomegalovirus (CMV) usually causes an asymptomatic infection in immunocompetent patients but could lead to more severe complications in immunocompromised patients.¹ The rate of seropositivity for CMV has been reported to be up to 90% of the population in some studies.²

A recent study published in the Journal of Infectious Diseases investigated the seroprevalence and predictors of CMV infection prospectively in an Italian cohort of HIV-infected subjects. The study also aimed to determine whether CMV-seropositive status was associated with the risk of developing either AIDS or severe non-AIDS events and AIDS-related or non–AIDS-related death.³

The study analyzed the records 10,129 subjects naive to antiretroviral drugs at baseline, collecting demographic, clinical, and laboratory data as well as history of therapies. Of these, 6111 patients met inclusion criteria of whom 5119 (83.3%) had a positive CMV-IgG test at baseline. The study found that patients who were seropositive for CMV at baseline had a higher risk of developing severe non-AIDS event/non-AIDS death (AHR, 1.53; 95% CI,1.08-2.16). The heightened risk was most pronounced for cardiovascular and cerebrovascular diseases (AHR, 2.27; 95% CI, 0.97-5.32) for which CMV seropositivity was found to be an independent risk factor.³ There was no significant association found between CMV seropositive status and non-AIDS malignancies (AHR, 1.98; 95% CI, 0.73 -5.36]; P = .17).³

The association between CMV seropositivity and increased cardiovascular and cerebrovascular diseases is biologically plausible given the possible role for CMV in accelerating atherosclerosis. Primary care physicians caring for patients infected with HIV should be aware of the implications of CMV seropositivity in this population and the role it may play in development of atherosclerosis.

References:

1. Britt W. Manifestations of human cytomegalovirus infection: proposed mechanisms of acute and chronic disease. Curr Top Microbiol Immunol. 2008;325: 417-470.

2. Hecker M, Qiu D, Marquardt K, Bein G, Hackstein H. Continuous cytomegalovirus seroconversion in a large group of healthy blood donors.Vox Sang. 2004;86:41-44.

3. Lichtner M, Cicconi P, Vita S, et al; for the Icona Foundation Study. 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. pii: jiu417. [Epub ahead of print]