Fang Mingxia, Miao Mengjiao, Lin Xiaoling, Wang Weixiao, Wang Qingqiang, Liu Lanxia, Cheng Cong, Chi Yun, Wei Hongxia, Chen Wei, Hu Zhiliang
Department of Infectious Diseases, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, 1-1 Zhongfu Road, Nanjing, Jiangsu, 210003, China.
Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
BMC Infect Dis. 2025 Apr 11;25(1):506. doi: 10.1186/s12879-025-10926-2.
Gastrointestinal (GI) cytomegalovirus (CMV) infection remains an important cause of morbidity among persons with HIV (PWH), even in the late antiretroviral therapy (ART) era. However, its varied clinical presentations and outcomes are not fully understood.
We conducted a retrospective review of 21 PWH with histologically confirmed GI-CMV infections admitted to a tertiary hospital in Nanjing, China, between September 2018 and September 2023. Clinical features, endoscopic findings, histology, treatment responses, and outcomes were examined.
Patients were predominantly male (95.2%) with a median age of 42 years. Over 80% had CD4 cell counts below 50 cells/µL; at admission, they were not on effective ART or had only recently initiated it, with a median HIV viral load of 5.2 log copies/mL (IQR: 4.9-5.7). Diarrhea (71.4%) was the most common presentation, followed by fever (52.4%), abdominal pain (47.6%), and GI bleeding (38.1%). The median symptom duration was 2.0 months (IQR: 1.0-5.0). Nearly half the patients had concurrent CMV end-organ disease-most commonly CMV retinitis-and 95.2% had at least one AIDS-defining illness; GI mycobacterial co-infection was found in three patients. The colon was the most frequently affected GI site, followed by the stomach and esophagus. Endoscopic findings included ulcers, erosions, proliferative lesions, and diffuse mucosal hemorrhage. All patients initially received intravenous ganciclovir and/or foscarnet for a median of 30 days (IQR: 20-39). The 9 patients with CMV retinitis were given oral ganciclovir maintenance. Gastrointestinal surgery was needed in 9.5% of cases. The 6-month mortality rate was 4.8%.
GI-CMV infection primarily affects PWH with profound immunosuppression (CD4 < 50 cells/µL) and inadequate or absent ART. These patients frequently have other AIDS-defining illnesses and CMV end-organ diseases, complicating their management. For PWH with GI-CMV infection, clinicians should address not only CMV itself but also coexisting conditions arising from advanced immunodeficiency to improve outcomes.
即使在抗逆转录病毒疗法（ART）晚期时代，胃肠道（GI）巨细胞病毒（CMV）感染仍是艾滋病毒感染者（PWH）发病的重要原因。然而，其多样的临床表现和结局尚未完全明确。
我们对2018年9月至2023年9月间在中国南京一家三级医院收治的21例经组织学确诊为胃肠道CMV感染的艾滋病毒感染者进行了回顾性研究。检查了临床特征、内镜检查结果、组织学、治疗反应和结局。
患者以男性为主（95.2%），中位年龄为42岁。超过80%的患者CD4细胞计数低于50个/µL；入院时，他们未接受有效的抗逆转录病毒治疗或仅最近开始接受治疗，艾滋病毒病毒载量中位数为5.2 log拷贝/mL（IQR：4.9 - 5.7）。腹泻（71.4%）是最常见的表现，其次是发热（52.4%）、腹痛（47.6%）和胃肠道出血（38.1%）。症状持续时间中位数为2.0个月（IQR：1.0 - 5.0）。近一半患者同时患有CMV终末器官疾病——最常见的是CMV视网膜炎——95.2%的患者至少有一种艾滋病定义疾病；3例患者发现胃肠道分枝杆菌合并感染。结肠是最常受累的胃肠道部位，其次是胃和食管。内镜检查结果包括溃疡、糜烂、增生性病变和弥漫性黏膜出血。所有患者最初接受静脉注射更昔洛韦和/或膦甲酸钠，中位时间为30天（IQR：20 - 39）。9例CMV视网膜炎患者接受口服更昔洛韦维持治疗。9.5%的病例需要进行胃肠道手术。6个月死亡率为4.8%。
胃肠道CMV感染主要影响免疫抑制严重（CD4＜50个/µL）且抗逆转录病毒治疗不足或未接受治疗的艾滋病毒感染者。这些患者经常患有其他艾滋病定义疾病和CMV终末器官疾病，使其治疗复杂化。对于患有胃肠道CMV感染的艾滋病毒感染者，临床医生不仅应治疗CMV本身，还应处理因晚期免疫缺陷引起的并存疾病，以改善结局。
