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Decrease of cytomegalovirus replication in human immunodeficiency virus infected-patients after treatment with highly
C E O'Sullivan1, W L Drew, D J McMullen
1Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham AL 39294-0006, USA. infd037@uabdpo.dpo.uab.edu
The Journal of Infectious Diseases
|August 7, 1999
Summary
Highly active antiretroviral therapy (HAART) effectively restores immune function in patients with human immunodeficiency virus (HIV). This immune reconstitution leads to a significant reduction in cytomegalovirus (CMV) viremia without specific anti-CMV treatments.
Area of Science:
- Infectious Diseases
- Immunology
- Virology
Background:
- Cytomegalovirus (CMV) is a common opportunistic infection in individuals with human immunodeficiency virus (HIV).
- Highly active antiretroviral therapy (HAART) has transformed HIV management by restoring immune function.
- Monitoring CMV viremia can serve as an indicator of immune reconstitution in HIV patients.
Purpose of the Study:
- To evaluate the effectiveness of immune reconstitution, driven by HAART, in controlling CMV viremia.
- To assess the impact of HAART on both HIV viral load and CMV DNA levels.
- To determine if specific anti-CMV therapy is necessary during HAART-induced immune recovery.
Main Methods:
- A cohort of 28 HIV-infected patients, predominantly treatment-naive, were enrolled.
- CMV viremia was quantified using a hybrid capture assay.
- Longitudinal measurements of CMV DNA, HIV RNA, and CD4 T cell counts were performed before and after HAART initiation.
Main Results:
- Following HAART initiation, median CMV DNA levels showed a progressive decline from 4.0 log10 copies/106 WBCs at 33 days to 2.5 log10 copies/106 WBCs at 385 days.
- Concurrently, median HIV RNA levels decreased significantly from 5.1 log10 copies/mL to 1.7 log10 copies/mL at 385 days.
- Median CD4 T cell counts increased from 35 cells/mm3 to 166 cells/mm3 over the same period, indicating successful immune reconstitution.
Conclusions:
- HAART-induced immune reconstitution significantly suppresses CMV viremia in HIV-infected individuals.
- The decline in CMV viremia occurs naturally as immune function recovers, without the need for concurrent anti-CMV therapy.
- Monitoring CMV viremia provides a valuable metric for assessing the efficacy of HAART in restoring immune competence.