Virus Predicts Progression to AIDS, Death

In patients infected with HIV, the presence of another virus in the blood called cytomegalovirus (CMV) increases their risk of developing AIDS and their risk of death. In fact, in the current study, the detection of CMV during follow-up was actually a better predictor of death than the HIV level itself.

In patients infected with HIV, the presence of another virus in the blood called cytomegalovirus (CMV) increases their risk of developing AIDS and their risk of death. In fact, in the current study, the detection of CMV during follow-up was actually a better predictor of death than the HIV level itself. Numerous reports have linked CMV with progression of HIV disease. The new findings add to this by showing that even after the introduction of highly active antiretroviral therapy (HAART) in the mid-1990s, the association persists. HAART involves the combined use of various anti-HIV drugs and it has been credited with dramatically improving the survival of HIV-infected patients. “In the era of HAART, there has been a dramatic decline in the” rates of CMV-related disease, senior author Dr. Paul D. Griffiths, from the Royal Free and University College Medical School in London, told Reuters Health. “But our results indicate that CMV infection is still present and it is still associated with progression of HIV disease.” The findings, which appear in The Lancet, are based on a study of 374 HIV-infected patients who were seen at the authors’ institution after January 1st 1997 and followed for about 37 months. Nearly 95 percent of the patients were treated with HAART at some point during the study. About 69 percent of patients tested negative for CMV throughout the study period, the authors report. In 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. By contrast, HIV levels during follow-up predicted progression to AIDS, but not death. CMV status is an important predictor of disease progression that, when coupled with HIV and immune cell testing, can help guide patient management, Griffiths said. “I think most (doctors) aren’t measuring CMV because they think it’s something that’s gone away” with the introduction of HAART. Griffiths observed that it remains to be determined whether CMV positivity is simply a predictor for disease progression or whether it actually causes it. He added that a trial involving patients treated with an anti-CMV drug or inactive “placebo” is currently underway and that should help answer this question. (Source: The Lancet, Reuters Health, June, 2004)