Department of Pediatrics, University of British Columbia, Vancouver, Canada.
CIHR Canadian HIV Trials Network, Vancouver, Canada.
PLoS One. 2023 Aug 4;18(8):e0287516. doi: 10.1371/journal.pone.0287516. eCollection 2023.
Co-infection with HIV can result in impaired control of cytomegalovirus (CMV) replication, increasing the likelihood of disease and onward transmission. The objective of this analysis was to measure the impact of HIV on CMV replication in an intensively-sampled cohort in Kampala, Uganda.
CMV seropositive men and women aged 18-65, with or without HIV co-infection, were followed for one month. Daily oral swabs and weekly anogenital swabs and plasma were collected. Quantitative CMV PCR was performed on all samples.
Eighty-five participants were enrolled and provided ≥1 oral swab; 43 (51%) were HIV-seropositive. People living with HIV (PLWH; median CD4 count 439 cells/mm3; none on antiretrovirals) had 2-4 times greater risk of CMV detection at each anatomical site assessed. At the oral site, 773 of 1272 (61%) of samples from PLWH had CMV detected, compared to 214 of 1349 (16%) among people without HIV. Similarly, the mean CMV quantity was higher among PLWH at all anatomical sites, with the largest difference seen for oral swabs (mean difference 1.63 log/mL; 95% CI 1.13-2.13). Among PLWH, absolute quantity of CD4+ T-cells was not associated with risk of CMV detection. HIV plasma RNA quantity was positively correlated with oral CMV shedding frequency, but not detection at other sites.
Mucosal and systemic CMV replication occurs at higher levels in PLWH than people without HIV, particularly oral shedding, which is a major mode of CMV transmission. Increased CMV replication despite relatively preserved CD4+ T-cell counts suggests that additional interventions are required to improve CMV control in PLWH.
艾滋病毒合并感染可导致巨细胞病毒（CMV）复制控制受损，增加疾病和进一步传播的可能性。本分析的目的是在乌干达坎帕拉的一个密集采样队列中测量艾滋病毒对 CMV 复制的影响。
对 CMV 血清阳性、年龄在 18-65 岁之间、无论是否合并 HIV 感染的男性和女性进行为期一个月的随访。每天采集口腔拭子，每周采集肛生殖器拭子和血浆。对所有样本进行定量 CMV PCR。
共纳入 85 名参与者，并提供了≥1 份口腔拭子；其中 43 名（51%）为 HIV 血清阳性。与未感染 HIV 的人群相比，携带艾滋病毒的人（中位 CD4 计数 439 个细胞/mm3；均未接受抗逆转录病毒治疗）在每个评估的解剖部位检测到 CMV 的风险增加了 2-4 倍。在口腔部位，PLWH 中 1272 个样本中的 773 个（61%）检测到 CMV，而在没有 HIV 的人群中 1349 个样本中的 214 个（16%）。同样，在所有解剖部位，PLWH 的 CMV 数量均较高，口腔拭子的差异最大（平均差异 1.63 log/mL；95%CI 1.13-2.13）。在 PLWH 中，绝对 CD4+ T 细胞数量与 CMV 检测风险无关。HIV 血浆 RNA 数量与口腔 CMV 脱落频率呈正相关，但与其他部位的检测无关。
PLWH 中黏膜和全身 CMV 复制水平高于未感染 HIV 的人群，尤其是口腔脱落，这是 CMV 传播的主要方式。尽管 CD4+ T 细胞计数相对保留，但 CMV 复制增加表明需要采取额外的干预措施来改善 PLWH 的 CMV 控制。
