Clinical relevance of cytomegalovirus viraemia(*,†) - PubMed (original) (raw)
. 2011 Aug;12(7):394-402.
doi: 10.1111/j.1468-1293.2010.00900.x. Epub 2011 Jan 19.
C Combescure, S Yerly, A Calmy, L Kaiser, B Hasse, H Furrer, M Cavassini, P Vernazza, Hh Hirsch, E Bernasconi, B Hirschel; Swiss HIV Cohort Study
Affiliations
- PMID: 21251182
- DOI: 10.1111/j.1468-1293.2010.00900.x
Free article
Clinical relevance of cytomegalovirus viraemia(*,†)
E Boffi El Amari et al. HIV Med. 2011 Aug.
Free article
Abstract
Background: Using new sensitive quantitative polymerase chain reaction (PCR) assays, cytomegalovirus (CMV) DNA is often detectable in the plasma of immunosuppressed patients. We investigated the prognostic value of a positive CMV DNA test for the development of CMV end-organ disease, other AIDS-defining events and mortality.
Methods: A survival analysis was performed, using the Kaplan-Meier method and Cox proportional hazards models, for patients prospectively followed in the Swiss HIV Cohort Study, from January 1996 to December 2007, who were CMV-seropositive, had a CD4 count of ≤ 100 cells/μL, and had a plasma sample available for the measurement of baseline CMV DNA with an ultrasensitive PCR. The outcome analysed was an AIDS-defining event, including CMV end-organ disease, or death. Variables analysed at the time of CMV measurement were demographic variables, CD4 cell counts, HIV-1 RNA loads, and use and type of highly active antiretroviral therapy (HAART).
Results: Of 1128 patients, 208 (18%) presented an AIDS-defining event and 246 (22%) died. A total of 368 patients (34% of samples) had detectable CMV DNA at baseline, with DNA concentrations of up to 38 800 copies/mL. In the multivariate analysis, CMV DNA predicted evolution not only towards CMV end-organ disease [hazard ratio (HR) 12.6; 95% confidence interval (CI) 4.27-37.41], but also towards other AIDS-defining events (HR 2.6; 95% CI 1.60-4.33) and death (HR 1.9; 95% CI 1.10-3.34).
Conclusion: Quantitative CMV DNA detected in the plasma of HIV-infected patients with CD4 counts ≤ 100 cells/μL is a predictor for HIV disease progression, CMV disease and death. A single low value of 80 copies/mL identifies patients at low but significantly increased risk during the following months, after the measurement.
© 2011 British HIV Association.
Comment in
- Cytomegalovirus viraemia in the modern antiretroviral era(*).
Jacobson M, Lurain N, Hunt P. Jacobson M, et al. HIV Med. 2011 Aug;12(7):387-8. doi: 10.1111/j.1468-1293.2010.00899.x. HIV Med. 2011. PMID: 21729228 No abstract available.
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