Lucas Júnior Rodovaldo M, Bogoni Giuliane, Reis Schneider Gustavo A, Castanheira de Souza Nidyanara F, Carvalho Maria Kassab, Vidal José Ernesto
Departamento de Infectologia, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.
Departamento de Infectologia, Pontifícia Universidade Católica de Campinas, São Paulo, Brazil.
Int J STD AIDS. 2023 Mar;34(4):229-235. doi: 10.1177/09564624221124697. Epub 2022 Sep 6.
AIDS-related cytomegalovirus (CMV) encephalitis has declined in the combined antiretroviral therapy (ART) era in high-income countries. However, there is scarce information on CMV encephalitis in low- and middle-income countries. The objectives of this study were to identify the prevalence of AIDS-related CMV encephalitis and describe its main features.
This was a retrospective cohort study carried out at a referral center in São Paulo, Brazil. We included adult people living with HIV/AIDS (PLWHA), hospitalized in 2019, with a CD4 cell count ≤100/mm and quantitation CMV DNA results in plasma. Cases with compatible neurological manifestations and detection of CMV DNA by polymerase chain reaction (PCR) in cerebrospinal fluid samples were defined as CMV encephalitis.
Among 761 PLWHA hospitalized, 248 (32.5%) cases were included in this study. Prevalence of CMV encephalitis was 2.4% (6/248) among all included cases and 7.7% (6/78) among individuals with neurological opportunistic diseases. The six patients with CMV encephalitis were males and had CD4 cell count <50/mm. Five (83%) cases had CMV encephalitis as AIDS-defining disease and showed CMV DNA detection by PCR >50,000 UI/mL plasma. All six cases received anti-CMV therapy (ganciclovir, = 4; ganciclovir plus foscarnet, = 2) and five were discharged to home. CMV encephalitis was not uncommon among hospitalized PLWHA with neurological opportunistic diseases.
The epidemiological and immunological profile of individuals with CMV encephalitis was similar to that described in the pre-ART era, but in contrast, most cases were treated and discharged from the hospital.
在高收入国家，联合抗逆转录病毒治疗（ART）时代，与艾滋病相关的巨细胞病毒（CMV）脑炎发病率有所下降。然而，关于低收入和中等收入国家CMV脑炎的信息却很少。本研究的目的是确定与艾滋病相关的CMV脑炎的患病率，并描述其主要特征。
这是一项在巴西圣保罗一家转诊中心进行的回顾性队列研究。我们纳入了2019年住院的成年艾滋病毒/艾滋病患者（PLWHA），其CD4细胞计数≤100/mm³，且血浆中CMV DNA定量检测结果可用。脑脊液样本中具有神经系统表现且通过聚合酶链反应（PCR）检测到CMV DNA的病例被定义为CMV脑炎。
在761名住院的PLWHA中，248例（32.5%）被纳入本研究。在所有纳入病例中，CMV脑炎的患病率为2.4%（6/248），在患有神经系统机会性疾病的个体中为7.7%（6/78）。6例CMV脑炎患者均为男性，CD4细胞计数<50/mm³。5例（83%）病例的CMV脑炎被定义为艾滋病确定疾病，血浆PCR检测显示CMV DNA>50,000 UI/mL。所有6例均接受了抗CMV治疗（更昔洛韦，n = 4；更昔洛韦加膦甲酸钠，n = 2），5例出院回家。CMV脑炎在患有神经系统机会性疾病的住院PLWHA中并不少见。
CMV脑炎患者的流行病学和免疫学特征与ART时代之前描述的相似，但不同的是，大多数病例接受了治疗并出院。
