Quisias Joshua, Gill M John, Coburn Sally B, Krentz Hartmut B, Beckthold Brenda, Fonseca Kevin, Parkins Michael D, Lang Raynell
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Southern Alberta Clinic, Alberta Health Services, Calgary, Alberta, Canada.
HIV Med. 2025 Jul;26(7):1074-1085. doi: 10.1111/hiv.70036. Epub 2025 Apr 28.
Cytomegalovirus (CMV) infection is common among people with HIV (PWH), and may be associated with negative outcomes. We aimed to identify the seroprevalence of CMV between 01 January 1998 and 01 June 2022 among PWH accessing care at the Southern Alberta Clinic (SAC) and the associated risk factors. We also aimed to assess the impact of CMV seropositivity on CD4+ T-cells and CD4+/CD8+ ratio recovery among PWH who maintain HIV viral suppression.
Poisson regression models with robust variance estimated crude and adjusted prevalence ratios and 95% confidence intervals to identify risk factors for CMV seronegativity. Among PWH maintaining viral suppression, trends in the median CD4+ T-cell count and CD4+/CD8+ ratio were visualized, and continuous time-to-event Cox proportional hazard models estimated hazards ratios (aHR) for CD4+ cell count recovery to ≥500 cells/mm and CD4+/CD8+ ratio of >1 at 10 years by CMV serostatus.
Among 3249 PWH, 2954 (91%) were CMV seropositive. CMV seronegativity was associated with younger ages, male sex, non-Hispanic white race and an education of ≥12 years. While CMV seronegativity did not affect CD4+ T-cell recovery following HIV viral suppression (aHR 1.15 [0.89-1.48]), it was associated with a greater likelihood of CD4+/CD8+ ratio normalization (aHR 2.38 [1.85-3.07]) at 10 years of follow-up.
CMV is a common coinfection among PWH. We found that CMV positivity among PWH maintaining HIV viral suppression, while not associated with CD4+ T-cell recovery, was associated with a reduced CD4+/CD8+ ratio recovery. This suggests an association with chronic CMV infection-mediated immune activation and inflammation among PWH.
巨细胞病毒（CMV）感染在艾滋病病毒感染者（PWH）中很常见，且可能与不良后果相关。我们旨在确定1998年1月1日至2022年6月1日期间在艾伯塔省南部诊所（SAC）接受治疗的PWH中CMV的血清阳性率及相关危险因素。我们还旨在评估CMV血清阳性对维持HIV病毒抑制的PWH中CD4 + T细胞和CD4+/CD8+比值恢复的影响。
采用具有稳健方差估计的泊松回归模型来计算粗患病率和调整患病率比值以及95%置信区间，以确定CMV血清阴性的危险因素。在维持病毒抑制的PWH中，观察CD4 + T细胞计数中位数和CD4+/CD8+比值的变化趋势，并通过连续时间事件Cox比例风险模型按CMV血清状态估计10年时CD4 +细胞计数恢复至≥500个细胞/mm和CD4+/CD8+比值>1的风险比（aHR）。
在3249名PWH中，2954名（91%）为CMV血清阳性。CMV血清阴性与年龄较小、男性、非西班牙裔白人种族以及受教育年限≥12年相关。虽然CMV血清阴性不影响HIV病毒抑制后CD4 + T细胞的恢复（aHR 1.15 [0.89 - 1.48]），但在随访10年时，它与CD4+/CD8+比值正常化的可能性更大相关（aHR 2.38 [1.85 - 3.07]）。
CMV是PWH中常见的合并感染。我们发现，在维持HIV病毒抑制的PWH中，CMV阳性虽然与CD4 + T细胞恢复无关，但与CD4+/CD8+比值恢复降低有关。这表明在PWH中，CMV感染与慢性免疫激活和炎症之间存在关联。
