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Virus Predicts Progression to AIDS, Death

June 30, 2004

A new study shows the detection of cytomegalovirus (CMV) in the blood of HIV patients during follow-up was a better predictor of death than the HIV level itself. The new findings add to the linkage of CMV with HIV progression by showing that the association has continued even since the introduction of highly active antiretroviral therapy (HAART) in the mid-1990s.

"In the era of HAART, there has been a dramatic decline in the" rates of CMV-related disease, according to Dr. Paul D. Griffiths of the Royal Free and University College Medical School in London, one of the authors. "But our results indicate that CMV infection is still present and it is still associated with progression of HIV disease," Griffiths said.

The findings are based on a study of 374 HIV-infected patients seen at the author's institution after Jan. 1, 1997, and followed-up for about 37 months. Nearly 95 percent of the patients received HAART at some point in the study.

About 69 percent of patients tested negative for CMV throughout the study period, the authors reported. By contrast, 4 percent of patients were persistently CMV-positive, and 27 percent were intermittently positive. CMV positivity during follow-up doubled the risk of progressing to AIDS and quadrupled the risk of death. HIV levels during follow-up predicted progression to AIDS, but not death.

Griffiths said CMV status is an important predictor of disease progression that, when coupled with HIV and immune cell testing, can help guide patient management. "I think most [doctors] aren't measuring CMV because they think it's something that's gone away" with the introduction of HAART, he said.

Griffiths said it is not known whether CMV positivity is simply a predictor for disease progression or actually its cause. A current trial in which patients are being treated with either an anti-CMV drug or an inactive placebo should help answer the question, he said.

The study, "Importance of Cytomegalovirus Viraemia in Risk of Disease Progression and Death in HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy," appeared in The Lancet (2004;363(9427):2116-2121).

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Excerpted from:
Reuters Health
06.28.04; Anthony J. Brown, M.D.

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