Cytomegalovirus (CMV) viremia is suppressed after the start of antiretroviral treatment (ART) without specific anti-CMV treatment, according to data presented at the virtual Conference on Retroviruses and Opportunistic Infections (CROI), held from March 8 to 11, 2020.
Although the prevalence of CMV viremia is roughly 30% in patients with HIV with ≤100 CD4 T lymphocytes, the prevalence of CMV end-organ disease is very low. Investigators hypothesized that immune reconstitution after initiation of ART may be the best strategy to clear CMV viremia, rather than anti-CMV treatments.
To investigate the dynamics of CMV viral replication and the recovery of specific immune response against CMV after beginning ART, investigators conducted a prospective observational study. A total of 53 patients with HIV and ≤100 CD4 T lymphocytes were included. The median age of patients was 43.5 years (interquartile range [IQR], 35.7-52.4 years), and 19 patients were women.
The baseline median CD4 T-lymphocyte count was 30/µL (IQR, 20-60/µL), and median HIV viral load was 510,000 copies/mL (IQR, 186,000-1,300,000 copies/mL). Detectable CMV viremia was evidenced in 18 patients at baseline, which then decreased to 0 patients at weeks 12 and 48. One patient developed end-organ disease (stomatitis) at follow-up, and 7 patients were lost to follow-up. There were 6 deaths, none of which was related to CMV infection.
Specific immune response against CMV was assessed using QuantiFERON, and 38 patients demonstrated a CMV-specific response at baseline compared with 28 patients at week 48. The specific CMV IFN γ response increased from a baseline median of 1.66 (IQR, 0.16-5.52) to a median of 2.53 (IQR, 0.1-7.99) at week 48 in the 40 patients who completed the follow-up (P = .048).
Investigators believe that a sustained CMV-specific immune response might explain the high prevalence of CMV viremia in patients with advanced HIV infection, but low incidence of CMV end-organ disease.
Suanzes P, Albasanz A, Esperalba J, et al. CMV viremia in patients with advanced HIV infection: A 48 week follow-up study. Poster presented at: CROI 2020; March 8–11, 2020; Boston, MA. http://www.croiconference.org/sessions/cmv-viremia-patients-advanced-hiv-infection-48-week-follow-study. Accessed March 19, 2020.