Mihăilescu Raluca, Arama Victoria, Paraschiv Simona, Streinu-Cercel A, Oţelea D, Munteanu Daniela, Iosipenco Mihaela, Chiotan Carmen, Benea Otilia Elisabeta, Mărdărescu Mariana, Rădulescu Mihaela, Hristea Adriana, Ungurianu Rodica, Aramă S S, Cercel Anca Streinu, Călin Ruxandra, Băicuş C
Prof. Dr. Matei Balş National Institute of Infectious Diseases, Bucharest, Romania.
Rom J Intern Med. 2008;46(4):305-11.
(1) to evaluate the effect of HAART on CMV viraemia in co-infected patients, in the absence of specific anti-CMV therapy; (2) to compare 2 molecular biology techniques for the detection and quantification of CMV-DNA in these patients.
We present the preliminary data of an ongoing prospective research grant on newly diagnosed HIV seropositives, in a tertiary care hospital, during June 2006- June 2008. Clinical, virological (HIV and CMV viraemia) and immunological (CD4) screening was performed every 3 months. The CMV viraemia was performed by RoboGene Human Cytomegalovirus Quantification kit (aj Roboscreen). We retested all undetectable CMV viremia found in patients with CD4 <50/mmc, by CMV PCR kit (Qiagen Diagnostics). Both PCR reactions were performed on ABI Prism 7000 (Applied Biosystems).
Up to date, our study has included 105 HIV-infected subjects, who were seropositive for anti-CMV IgG antibodies. Average follow-up was 18 months. CMV viraemia was found detectable in 21 cases at first visit and in other 5 at the second visit. 22 cases had CD4 <50/mmc, among which 14 had undetectable CMV viraemia. The results of both molecular biology techniques were widely the same. HAART was prescribed to 86% of the patients; all the patients having detectable CMV viraemia received HAART, but not any specific anti-CMV therapy. Under HAART, all the detectable CMV loads which were retested in time became undetectable at next visits, after a median of 16.5 weeks from the introduction of therapy.
CMV viraemia detection was useful in early diagnosis of asymptomatic CMV infection. As opposed to transplant cases, molecular biology techniques for the detection and quantification of CMV-DNA in HIV-patients have not been standardized yet. In our study, the two kits RoboGene Human Cytomegalovirus (HCMV) Quantification kit (aj Roboscreen) and CMV PCR kit (Qiagen Diagnostics) were comparable. HAART made the reduction of CMV viral load, without any specific anti-CMV therapy. As in the case of other opportunistic infections, undetectable natural history of CMV infection seemed to have been improved by controlling HIV infection.
（1）在未进行特异性抗巨细胞病毒（CMV）治疗的情况下，评估高效抗逆转录病毒治疗（HAART）对合并感染患者CMV病毒血症的影响；（2）比较两种分子生物学技术在检测和定量这些患者CMV-DNA中的应用。
我们展示了一项正在进行的前瞻性研究资助的初步数据，该研究于2006年6月至2008年6月在一家三级护理医院对新诊断的HIV血清阳性患者进行。每3个月进行临床、病毒学（HIV和CMV病毒血症）和免疫学（CD4）筛查。CMV病毒血症检测采用RoboGene人巨细胞病毒定量试剂盒（aj Roboscreen）。我们对所有CD4<50/mm³患者中检测不到的CMV病毒血症，采用CMV PCR试剂盒（Qiagen诊断公司）进行重新检测。两种PCR反应均在ABI Prism 7000（应用生物系统公司）上进行。
截至目前，我们的研究纳入了105名HIV感染受试者，他们抗CMV IgG抗体血清学呈阳性。平均随访时间为18个月。首次就诊时发现21例可检测到CMV病毒血症，第二次就诊时又发现5例。22例患者CD4<50/mm³，其中14例CMV病毒血症检测不到。两种分子生物学技术的结果大致相同。86%的患者接受了HAART治疗；所有检测到CMV病毒血症的患者均接受了HAART治疗，但未接受任何特异性抗CMV治疗。在HAART治疗下，所有及时重新检测的可检测到的CMV载量在开始治疗后的中位16.5周后的下次就诊时均变为检测不到。
CMV病毒血症检测有助于无症状CMV感染的早期诊断。与移植病例不同，用于检测和定量HIV患者CMV-DNA的分子生物学技术尚未标准化。在我们的研究中，RoboGene人巨细胞病毒（HCMV）定量试剂盒（aj Roboscreen）和CMV PCR试剂盒（Qiagen诊断公司）这两种试剂盒具有可比性。HAART在未进行任何特异性抗CMV治疗的情况下降低了CMV病毒载量。与其他机会性感染情况一样，控制HIV感染似乎改善了CMV感染难以检测到的自然病程。
