Steininger Christoph, Puchhammer-Stöckl Elisabeth, Popow-Kraupp Theresia
Department of Internal Medicine I, Division of Infectious Diseases, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
J Clin Virol. 2006 Sep;37(1):1-9. doi: 10.1016/j.jcv.2006.03.005. Epub 2006 May 3.
Cytomegalovirus (CMV) infection was one of the most important opportunistic infections in HIV-infected patients before the introduction of highly active antiretroviral therapy (HAART), i.e. the combination of at least three antiretroviral drugs of different classes. Thereafter, life expectancy and quality of life increased dramatically with the persistent suppression of HIV viremia and a significant reduction in incidence of CMV disease. Nevertheless, evidence for a multitude of direct and indirect effects of CMV on HIV progression is accumulating. Even in the era of HAART, a considerable number of HIV-infected patients have a CD4 cell count below <100 mm(-3), which involves a high risk for CMV disease. The focus of the present review is on interpretation of test results, their predictive value for CMV disease, and guidance for the rational use of diagnostic assays in HIV-infected patients. Identification of patients at immediate risk for CMV disease may be accomplished by detection of CMV-DNA in leucocytes or plasma. Evidence is growing that CMV genotypes may be also relevant for the risk of CMV disease. Diagnosis of CMV disease requires in most instances demonstration of virus in biopsy specimen from the affected organ because presence of CMV in blood may not be causally related to symptoms observed. Clinical symptoms and patient characteristics are essential in the interpretation of laboratory test results and may guide the rational collection of clinical specimen and use of laboratory assays. As a consequence, a reliable diagnosis of CMV disease and early identification of patients at high risk for CMV disease requires an integrated interpretation of clinical and virological information.
在高效抗逆转录病毒疗法（HAART），即至少三种不同类别的抗逆转录病毒药物联合使用之前，巨细胞病毒（CMV）感染是HIV感染患者最重要的机会性感染之一。此后，随着HIV病毒血症的持续抑制以及CMV疾病发病率的显著降低，患者的预期寿命和生活质量大幅提高。然而，关于CMV对HIV进展的多种直接和间接影响的证据正在不断积累。即使在HAART时代，仍有相当数量的HIV感染患者CD4细胞计数低于100/mm³，这使他们面临较高的CMV疾病风险。本综述的重点是检测结果的解读、其对CMV疾病的预测价值以及指导HIV感染患者合理使用诊断检测方法。通过检测白细胞或血浆中的CMV-DNA，可以识别出有CMV疾病直接风险的患者。越来越多的证据表明，CMV基因型可能也与CMV疾病风险相关。在大多数情况下，CMV疾病的诊断需要在来自受影响器官的活检标本中发现病毒，因为血液中CMV的存在可能与观察到的症状没有因果关系。临床症状和患者特征对于解读实验室检测结果至关重要，并且可以指导临床标本的合理采集和实验室检测方法的使用。因此，要对CMV疾病进行可靠诊断并早期识别CMV疾病高危患者，需要对临床和病毒学信息进行综合解读。
