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Cytomegalovirus infection
1University of California, San Francisco.
Abstract:
The pathogenic importance of cytomegalovirus (CMV) infection in AIDS-associated pneumonitis is controversial. Uncertainty regarding the significance of CMV isolation from pulmonary secretions of AIDS patients results in part from the difficulty in distinguishing CMV infection from CMV disease and from the high frequency of pulmonary CMV co-infection with other opportunistic pathogens. From our review of the literature to date, we have found only three cases in which AIDS patients with hypoxemia and infiltrates on chest x-ray had lung biopsy or autopsy material reported to demonstrate CMV cytopathic effect in the absence of any other pathogen. However, pulmonary CMV co-infection may be a marker of poor outcome in Pneumocystis carinii pneumonia. In this article, appropriate criteria for instituting specific therapy with the antiviral drug ganciclovir are described.
Insights
Cytomegalovirus (CMV) significance in AIDS-related pneumonia is unclear. While CMV co-infection may indicate poor outcomes in Pneumocystis pneumonia, definitive CMV lung disease is rare in AIDS patients.
Area of Science:
- Infectious Diseases
- Pulmonology
- Virology
Background:
- The role of cytomegalovirus (CMV) in acquired immunodeficiency syndrome (AIDS)-associated pneumonitis remains debated.
- Distinguishing CMV infection from CMV disease and managing frequent co-infections with other pathogens complicate assessments.
Purpose of the Study:
- To clarify the pathogenic significance of CMV in AIDS-associated pneumonitis.
- To define criteria for initiating ganciclovir therapy in relevant cases.
Main Methods:
- Literature review of reported cases of CMV in AIDS patients with pulmonary symptoms.
- Analysis of studies examining CMV co-infection in Pneumocystis carinii pneumonia.
Main Results:
- Few cases (three identified) show definitive CMV cytopathic effect in lung tissue without other opportunistic pathogens in AIDS patients with hypoxemia and infiltrates.
- Pulmonary CMV co-infection may serve as a prognostic marker for poor outcomes in Pneumocystis carinii pneumonia.
Conclusions:
- Evidence for CMV as a primary cause of pneumonitis in AIDS is limited.
- Criteria for ganciclovir treatment initiation in suspected CMV lung disease are discussed.