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should I take medicine on CMV?
Sep 11, 2007

Dr. Wohl,

I am 41, male. My CD4 tested three weeks ago was 234, a drop from 294 in 10 days. Total lymphocyte from 760 to 700. CD8 from 240 to 213, CD3=410. CMV IgG=43 AU/mL. EBNA positive EBV VCA IGM negative. I have peripheral neuropathy symptom. Couphing up a little clear mucus. My mouth taste very bad, sour powder like taste. The surface of tongue was slimy stick, quickly coated with white coating after 8 hours. No HIV can be detected so far. I am worried about CMV infection in organs especially CMV pneumonia. what does high concentration of CMV IgG mean? Should I take medication? My appointment to the ID doctor is two weeks later. I am eager to know. Thank you!

Response from Dr. Wohl

The CMV test you had measures antibodies that your body makes to CMV. It does not meausre the virus itself. Your test only indicates that you have made IgG type antibodies to CMV - indicating the infection was not recently. CMV infection is very common in humans and in many regions of the world the majority of the population has been infected. In the US, almost 90% of gay men have antibodies to CMV.

All this means is that some time ago you were infected with CMV. This could have been when you were a child playing with other children or as an adult when intimate with another. It does not mean you have active disease caused by CMV as the antibodies are always there in HIV+ and HIV- people who have been infected. The virus, like its sister viruses herpes simplex and varicella (chickpox virus), lies dormant but can reactivate to cause problems when the immune system falters.

At a CD4 over 200 it would be quite unusual for CMV to cause active disease. People with counts below 75 are more likely to develop CMV problems and in 80% it is in the form of disease of the retina of the eye. Pneumonia from CMV in HIV+ persons is rare.

Also, that drop in CD4 from 294 to 234 almost certainly just represents the variability in the test and day to day changes in CD4 cell counts. I would not look at this as a sign of declining immune function.

In short, don't worry about CMV. You may just have a cold. Go to your doc and see if these is anything serious going on.

DW



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