Cytomegalovirus viremia and advanced HIV disease: is there an argument for anti-CMV treatment?

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Abstract

Introduction: The role of cytomegalovirus (CMV) infection as a co-factor in HIV disease has been a topic of considerable interest since the beginning of the HIV pandemic. CMV is believed to function both as a co-factor in the progression of HIV infection, and as a contributor to enhanced disease for other opportunistic infections. Areas covered: In this special article, we review several recent studies that have enhanced our understanding of the role that CMV infection plays in the natural history of other HIV-related opportunistic infections. We review the clinical evidence that demonstrates how CMV viremia has emerged as an independent risk factor for the progression of infections such as those caused by C. neoformans and M. tuberculosis. We outline the biological underpinnings of the various hypotheses by which CMV, as an immunomodulatory virus, may modify the natural history of HIV-related infections. Expert opinion: Evidence suggests that active CMV replication, manifest as CMV viremia (DNAemia), may play a key role in driving progression of HIV-associated opportunistic infections. We propose that control of CMV replication, independent of the known benefit of HAART therapy on reducing CMV end-organ disease, could reduce the risk of disease and mortality attributable to opportunistic infections such as cryptococcosis and tuberculosis. This could be achieved by the targeted use of CMV antivirals. The advent of newer (and safer) orally bioavailable CMV antivirals has renewed interest in, and opportunities for, randomized controlled trials to evaluate CMV viremia as a modifiable risk factor in high-risk persons with HIV disease.

Original languageEnglish (US)
Pages (from-to)227-233
Number of pages7
JournalExpert review of anti-infective therapy
Volume21
Issue number3
DOIs
StatePublished - 2023

Bibliographical note

Funding Information:
This research was made possible by the National Institutes of Health’s National Center for Advancing Translational Sciences (KL2TR002492 and UL1TR002494); Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD079918); and the Fogarty International Center (D43TW009345).

Publisher Copyright:
© 2023 Informa UK Limited, trading as Taylor & Francis Group.

Keywords

  • CMV
  • HIV
  • antiviral therapy
  • cryptococcal meningitis
  • valganciclovir

PubMed: MeSH publication types

  • Review
  • Journal Article
  • Research Support, N.I.H., Extramural

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