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Cytomegalovirus in the lungs of patients with AIDS. Respiratory pathogen or passenger?
A B Millar1, G Patou, R F Miller
1Department of Medicine, University College and Middlesex School of Medicine, London, England.
Abstract:
A total of 166 consecutive clinical episodes of pneumonitis in patients with acquired immune deficiency syndrome (AIDS) or antibody positive for human immune deficiency virus (HIV) were investigated for evidence of cytomegalovirus (CMV) infection in their lungs and at peripheral sites to determine the pathogenicity of this virus in the lung and its relationship to peripheral CMV shedding. Evidence of CMV infection was sought in bronchoalveolar lavage (BAL) fluid, blood, saliva, and urine using a specific monoclonal antibody to antigens produced by CMV-infected cells within 24 h. Although CMV was detected in 31 (19%) of BAL fluid specimens, in only six episodes was this the sole pathologic finding. In the remaining episodes either another infectious agent, Kaposi's sarcoma, or lymphoid interstitial pneumonitis was found or no pathogen was detected. None of the patients were given specific anti-CMV treatment, and all but two recovered, including those patients in whom CMV was the sole finding at BAL. The presence of peripheral shedding of CMV did not have any significance in mortality or morbidity. Our findings are in direct contrast to those in recipients of allogeneic bone marrow transplants, in whom CMV pneumonitis is associated with a high mortality. We postulate that this difference is because AIDS patients cannot mount the destructive immune response to CMV in the lung, which we believe to be the basis of the pathology seen in the former group. We conclude that CMV is not a pathogen in the lungs of patients with HIV infection, and we suggest that its presence at this site does not warrant specific therapy in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Cytomegalovirus (CMV) is not a lung pathogen in patients with human immune deficiency virus (HIV) infection. Its presence in bronchoalveolar lavage fluid does not require specific anti-CMV therapy in these individuals.
Area of Science:
- Infectious Diseases
- Virology
- Immunology
Background:
- Pneumonitis is a common complication in patients with acquired immune deficiency syndrome (AIDS) or human immune deficiency virus (HIV) infection.
- The role of cytomegalovirus (CMV) as a causative agent of pneumonitis in HIV-infected individuals is not fully understood.
- CMV pneumonitis has a high mortality rate in allogeneic bone marrow transplant recipients.
Purpose of the Study:
- To investigate the pathogenicity of cytomegalovirus (CMV) in the lungs of patients with acquired immune deficiency syndrome (AIDS) or human immune deficiency virus (HIV) infection.
- To determine the relationship between CMV detection in bronchoalveolar lavage (BAL) fluid and peripheral CMV shedding.
- To assess the clinical significance of CMV detection in HIV-infected patients with pneumonitis.
Main Methods:
- Analysis of 166 clinical episodes of pneumonitis in HIV-positive patients.
- Detection of CMV in bronchoalveolar lavage (BAL) fluid, blood, saliva, and urine using a specific monoclonal antibody.
- Correlation of CMV detection with other potential causes of pneumonitis, including Kaposi's sarcoma and lymphoid interstitial pneumonitis.
Main Results:
- CMV was detected in 19% of BAL fluid specimens.
- In most cases where CMV was detected, another pathogen or condition was also present.
- Patients with CMV detected in BAL fluid, even as the sole finding, generally recovered without specific anti-CMV treatment.
Conclusions:
- Cytomegalovirus (CMV) is not a primary lung pathogen in patients with HIV infection.
- The presence of CMV in the lungs of HIV-infected patients does not warrant specific anti-CMV therapy.
- HIV-infected patients may not mount the same destructive immune response to CMV in the lungs as seen in bone marrow transplant recipients.