Cytomegalovirus coinfection is associated with an increased risk of severe non-AIDS-defining events in a large cohort of HIV-infected patients.

Abstract

BACKGROUND:

Chronic cytomegalovirus (CMV) infection has been associated with immunosenescence and immunoactivation in the general population. In human immunodeficiency virus type 1 (HIV-1)-infected people, CMV coinfection, in addition to residual HIV replication and microbial translocation, has been proposed as a key factor in sustaining immune activation, even in individuals with a controlled HIV load.

METHODS:

Patients from the ICONA Study with at least 1 CMV immunoglobulin G (IgG) test available without active CMV disease were included in the analysis. AIDS-defining event or AIDS-related death and severe non-AIDS-defining event or non-AIDS-related death were taken as clinical progression end points. Independent predictors of CMV were identified by multivariable logistic regression. Probabilities of reaching the end points were estimated by survival analyses.

RESULTS:

A total of 6111 subjects were included, of whom 5119 (83.3%) were CMV IgG positive at baseline. Patients with CMV IgG positivity at baseline were more likely to develop a severe non-AIDS-defining event/non-AIDS-related death (adjusted hazard ratio [HR], 1.53 [95% confidence interval {CI}, 1.08-2.16]. In particular, CMV seropositivity was an independent risk factor for cardiovascular and cerebrovascular diseases (adjusted HR, 2.27 [95% CI, .97-5.32]).

CONCLUSIONS:

In our study population, CMV/HIV coinfection was associated with the risk of severe non-AIDS-defining events/non-AIDS-related death, especially with cardiovascular and cerebrovascular events, independently of other prognostic factors. This finding supports a potential independent role of CMV coinfection in vascular/degenerative organ disorders in HIV-infected subjects.

• Authors: Miriam Lichtner, Paola Cicconi, Serena Vita, Alessandro Cozzi-Lepri, Massimo Galli, Sergio Lo Caputo, Annalisa Saracino, Andrea De Luca, Mariacristina Moioli, Franco Maggiolo, Giulia Marchetti, Vincenzo Vullo, Antonella d'Arminio Monforte, ICONA Foundation Study
• Journal: The Journal of infectious diseases (J Infect Dis) Vol. 211 Issue 2 Pg. 178-86 (Jan 15 2015) ISSN: 1537-6613 [Electronic] United States
• PMID: 25081936 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected].

Chemical References

• Antibodies, Viral
• Immunoglobulin G

Topics

• AIDS-Related Opportunistic Infections (complications, epidemiology, immunology, pathology)
• Adult
• Antibodies, Viral (blood)
• Cardiovascular Diseases (epidemiology)
• Cerebrovascular Disorders (epidemiology)
• Cohort Studies
• Cross-Sectional Studies
• Cytomegalovirus Infections (immunology)
• Female
• Humans
• Immunoglobulin G (blood)
• Male
• Prospective Studies
• Risk Assessment