尽管晚期 HIV 感染患者的巨细胞病毒 (CMV) 血症流行率较高，但 CMV 疾病的发生率较低：一项临床和免疫学 48 周随访研究。

Low frequency of cytomegalovirus (CMV) disease despite high prevalence of CMV viraemia in patients with advanced HIV infection: a clinical and immunological 48-week follow-up study.

机构信息

Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.

Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain.

出版信息

HIV Med. 2021 Sep;22(8):682-689. doi: 10.1111/hiv.13115. Epub 2021 May 17.

DOI:10.1111/hiv.13115

PMID:33998115

Abstract

OBJECTIVES

The aim of the study was to investigate the dynamics of cytomegalovirus (CMV) replication and CMV-specific immune response recovery after antiretroviral treatment (ART) initiation in patients with advanced HIV infection.

METHODS

A prospective observational study of patients with HIV infection and CD4 counts of < 100 cells/µL was carried out (September 2015 to July 2018). HIV viral load (VL), CD4 count and CMV VL were determined by quantitative polymerase chain reaction (PCR) at baseline and at 4, 12, 24 and 48 weeks, and CMV-specific immune response was determined by QuantiFERON-CMV assay at baseline and 48 weeks. All patients were started on ART but only those with CMV end-organ disease (EOD) received anti-CMV treatment.

RESULTS

Fifty-three patients with a median age of 43.6 [interquartile range (IQR) 36.7-52.4] years were included in the study. At baseline, the median CD4 count was 30 cells/µL (IQR 20-60 cells/µL) and the median HIV VL was 462 000 HIV-1 RNA copies/mL (IQR 186 000-1 300 000 copies/mL). At baseline, 32% patients had detectable CMV viraemia but none had detectable CMV viraemia at 48 weeks. Only one of 53 (1.9%) patients developed EOD during follow-up. Seven (13.2%) patients were lost to follow-up and six (11.3%) died; none of the deaths was related to CMV. Similar percentages of patients had a CMV-specific immune response at baseline (71.7%) and at 48 weeks (70.0%). The magnitude of this response tended to increase over time [median 1.63 (IQR 0.15-5.77) IU/mL at baseline vs. median 2.5 (IQR 0.1-8.325) IU/mL at 48 weeks; P = 0.11]. We did not find any risk factors associated with 48-week mortality.

CONCLUSIONS

Although the prevalence of CMV viraemia in patients with advanced HIV infection remains high, achieving a good immunological recovery through ART is enough to suppress CMV viraemia, without an increased risk of CMV EOD. The prevalence of a CMV-specific immune response was high and endured over time.

摘要

目的

本研究旨在探讨在开始抗逆转录病毒治疗（ART）后，晚期 HIV 感染患者的巨细胞病毒（CMV）复制和 CMV 特异性免疫应答恢复的动力学。

方法

对 2015 年 9 月至 2018 年 7 月间 CD4 计数<100 个/μL 的 HIV 感染患者进行前瞻性观察研究。采用定量聚合酶链反应（PCR）在基线和第 4、12、24 和 48 周时测定 HIV 病毒载量（VL）、CD4 计数和 CMV VL，并在基线和第 48 周时采用 QuantiFERON-CMV 检测 CMV 特异性免疫应答。所有患者均开始接受 ART 治疗，但只有 CMV 终末器官疾病（EOD）患者接受抗 CMV 治疗。

结果

本研究共纳入 53 例中位年龄为 43.6 [四分位距（IQR）36.7-52.4]岁的患者。基线时，中位 CD4 计数为 30 个/μL（IQR 20-60 个/μL），中位 HIV VL 为 462000 HIV-1 RNA 拷贝/mL（IQR 186000-1300000 拷贝/mL）。基线时，32%的患者有可检测的 CMV 病毒血症，但在 48 周时均无可检测的 CMV 病毒血症。在随访期间，仅有 1 例（1.9%）患者发生 EOD。7 例（13.2%）患者失访，6 例（11.3%）死亡；均与 CMV 无关。在基线时（71.7%）和第 48 周时（70.0%），有相似比例的患者有 CMV 特异性免疫应答。该应答的幅度随时间推移呈增加趋势[基线时中位数为 1.63（IQR 0.15-5.77）IU/mL，第 48 周时中位数为 2.5（IQR 0.1-8.325）IU/mL；P=0.11]。我们未发现任何与第 48 周死亡率相关的危险因素。