Schnittman Samuel R, Hunt Peter W
Department of Medicine, University of California, San Francisco, California, USA.
Curr Opin HIV AIDS. 2021 May 1;16(3):168-176. doi: 10.1097/COH.0000000000000678.
Despite antiretroviral therapy (ART)-mediated viral suppression, people with human immunodeficiency virus (HIV) (PWH) have increased morbidity and mortality. Immune activation and inflammation persist on ART and predict these complications. Over 90% of PWH have cytomegalovirus (CMV) co-infection, and CMV is considered a plausible contributor to this persistent immune activation.
A detailed understanding of the link between CMV and multimorbidity is needed, particularly as research moves toward identifying potential targeted therapeutics to attenuate inflammation-mediated morbidity and mortality in treated HIV. We review the literature on the association between CMV and immune activation as well as multiple end-organ complications including cardiovascular disease, venous thromboembolic disease, metabolic complications, gastrointestinal dysfunction, central nervous system involvement, birth sex-related differences, and the relation to the HIV reservoir. We conclude with a discussion of ongoing therapeutic efforts to target CMV.
As CMV is a plausible driver of multiple comorbidities through persistent immune activation in treated HIV, future research is needed and planned to address its causal role as well as to test novel therapeutics in this setting.
尽管抗逆转录病毒疗法（ART）可抑制病毒，但感染人类免疫缺陷病毒（HIV）的人（PWH）的发病率和死亡率仍有所增加。免疫激活和炎症在接受ART治疗时持续存在，并预示着这些并发症。超过90%的PWH合并巨细胞病毒（CMV）感染，CMV被认为是导致这种持续免疫激活的一个可能因素。
需要详细了解CMV与多种疾病之间的联系，尤其是随着研究朝着确定潜在的靶向治疗方法以减轻接受治疗的HIV感染者中炎症介导的发病率和死亡率发展。我们综述了关于CMV与免疫激活以及多种终末器官并发症之间关联的文献，这些并发症包括心血管疾病、静脉血栓栓塞性疾病、代谢并发症、胃肠功能障碍、中枢神经系统受累、出生性别相关差异以及与HIV储存库的关系。我们最后讨论了针对CMV的正在进行的治疗努力。
由于CMV可能通过在接受治疗的HIV感染者中持续的免疫激活导致多种合并症，因此需要并计划开展未来研究，以确定其因果作用，并在这种情况下测试新型治疗方法。
