Lessons learned from HIV pathogenesis and therapy: implications for better management of cytomegalovirus disease

To review how developments in virological quantitation technology have altered our understanding of the pathogenesis of HIV infection, and the way in which we treat the disease, and to consider how we may apply this type of knowledge to improve the management of cytomegalovirus (CMV) infection.

HIV can no longer be regarded as the cause of a chronic, latent infection but rather as one that is active from the time of initial infection. The destruction of the immune system begins almost immediately after the primary infection is established. Throughout the course of the disease there is a constant war being waged between the rapidly replicating virus and the host's immune system.

Viral load has been found to be a reliable and discriminating marker for predicting prognosis in HIV disease and for the evaluation of anti-HIV therapies.

Unlike HIV, CMV is a truly latent infection with periods of active, detectable viral replication as well as quiescence. CMV DNA quantitation (CMV viral load), primarily by polymerase chain reaction can be used to determine when the infection becomes active in order to decide whether primary prophylaxis or pre-emptive therapy should be given. In this manner CMV viral load quantitation has considerable utility for monitoring the pathogenesis and type of treatment necessary for CMV infection in patients with AIDS.