TREAT Asia, amfAR/The Foundation for AIDS Research, Klongtoey, Bangkok 10110, Thailand.
Clin Infect Dis. 2013 Jul;57(1):147-55. doi: 10.1093/cid/cit173. Epub 2013 Mar 19.
Prevalence and risk factors of cytomegalovirus (CMV) viremia in patients infected with human immunodeficiency virus (HIV) starting antiretroviral therapy (ART) in developing countries are understudied.
We measured CMV DNA in stored plasma specimens of 293 Thai HIV patients starting ART at CD4 counts <200 cells/mm(3). We examined Cox proportional hazard ratios (HRs) of 24 months mortality and new AIDS-defining illness (ADI).
Of 293 patients, 159 (54.3%) were male. The median age was 33 years. The median baseline CD4 count was 82 cells/mm(3), and the median HIV-1 RNA was 4.9 log10 copies/mL. In total, 273 (93.2%) patients started potent combination ART, and 20 (6.8%) started dual nucleoside reverse transcriptase inhibitor (NRTI) therapy. CMV DNA was detected in 77 of 293 patients (26.3%) at baseline, and 9 of 199 patients with available specimen (4.5%) after 6 months of ART. The median CMV DNA was 548 copies/mL (interquartile range [IQR], 129-3849) at baseline and 114 copies/mL (IQR, 75-1099) at 6 months. In univariate analysis, death was associated with baseline CDC stage C, hemoglobin <10 g/dL, lower CD4 count, and CMV viremia. In multivariate analysis, only CMV DNA >500 copies/mL was significantly associated with mortality (HR: 7.28; 95% CI, 1.32-40.29, P = .023). CD4 count was the only variable associated with new ADI (HR: 0.70 per 50 CD4 cells increase; 95% CI, .49-.997, P = .048).
In these Thai patients with advanced HIV disease, CMV viremia was frequent, and CMV DNA >500 copies/mL predicted increased mortality despite ART initiation. This calls for increased attention to screening of active CMV infection in advanced HIV patients in developing countries. Trials assessing preemptive anti-CMV therapy may be warranted.
在发展中国家，开始抗逆转录病毒治疗（ART）的人类免疫缺陷病毒（HIV）感染者中，巨细胞病毒（CMV）血症的流行率和危险因素研究较少。
我们测量了 293 例泰国 HIV 患者的储存血浆标本中的 CMV DNA，这些患者的 CD4 计数<200 个细胞/mm³。我们检查了 24 个月死亡率和新发 AIDS 定义疾病（ADI）的 Cox 比例风险比（HR）。
293 例患者中，159 例（54.3%）为男性。中位年龄为 33 岁。中位基线 CD4 计数为 82 个细胞/mm³，中位 HIV-1 RNA 为 4.9 log10 拷贝/mL。共有 273 例（93.2%）患者开始使用强效联合 ART，20 例（6.8%）患者开始使用双核苷逆转录酶抑制剂（NRTI）治疗。基线时，293 例患者中有 77 例（26.3%）检测到 CMV DNA，199 例有可用标本的患者中有 9 例（4.5%）在 ART 后 6 个月时检测到。基线时 CMV DNA 的中位数为 548 拷贝/mL（四分位距 [IQR]，129-3849），6 个月时为 114 拷贝/mL（IQR，75-1099）。在单变量分析中，死亡与基线 CDC 分期 C、血红蛋白<10 g/dL、较低的 CD4 计数和 CMV 病毒血症有关。在多变量分析中，只有 CMV DNA>500 拷贝/mL 与死亡率显著相关（HR：7.28；95%CI，1.32-40.29，P=0.023）。CD4 计数是唯一与新发 ADI 相关的变量（HR：每增加 50 个 CD4 细胞增加 0.70；95%CI，0.49-0.997，P=0.048）。
在这些患有晚期 HIV 疾病的泰国患者中，CMV 病毒血症很常见，尽管开始了 ART，但 CMV DNA>500 拷贝/mL 预测死亡率增加。这呼吁在发展中国家对晚期 HIV 患者的 CMV 感染进行积极筛查。可能需要评估抢先抗 CMV 治疗的试验。
