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J Infect Dis. 2015 Jan 15;211(2):178-86. doi: 10.1093/infdis/jiu417. Epub 2014 Jul 31.

Cytomegalovirus coinfection is associated with an increased risk of severe non-AIDS-defining events in a large cohort of HIV-infected patients.

Collaborators (146)

Moroni M, Angarano G, Antinori A, Armignacco O, d'Arminio Monforte A, Castelli F, Cauda R, Di Perri G, Galli M, Iardino R, Ippolito G, Lazzarin A, Perno CF, von Schloesser F, Viale P, d'Arminio Monforte A, Antinori A, Castagna A, Ceccherini-Silberstein F, Cozzi- Lepri A, Girardi E, Caputo S, Mussini C, Puoti M, Andreoni M, Ammassari A, Antinori A, d'Arminio Monforte A, Balotta C, Bonfanti P, Bonora S, Borderi M, Capobianchi MR, Castagna A, Ceccherini-Silberstein F, Cingolani A, Cinque P, Cozzi-Lepri A, d'Arminio Monforte A, De Luca A, Di Biagio A, Girardi E, Gianotti N, Gori A, Guaraldi G, Lapadula G, Lichtner M, Lo Caputo S, Madeddu G, Maggiolo F, Marchetti G, Marcotullio S, Monno L, Mussini C, Puoti M, Quiros Roldan E, Rusconi S, Cozzi-Lepri A, Cicconi P, Fanti I, Formenti T, Galli L, Lorenzini P, Giacometti A, Costantini A, Angarano G, Monno L, Carrisa C, Maggiolo F, Suardi C, Viale P, Vanino E, Verucchi G, Castelli F, Quiros Roldan E, Minardi C, Quirino T, Abeli C, Manconi P, Piano P, Vecchiet J, Falasca K, Sighinolfi L, Segala D, Mazzotta F, Lo Caputo S, Cassola G, Viscoli G, Alessandrini A, Piscopo R, Mazzarello G, Mastroianni C, Belvisi V, Bonfanti P, Caramma I, Castelli A, Galli M, Lazzarin A, Rizzardini G, Puoti M, d'Arminio Monforte A, Ridolfo A, Piolini R, Castagna A, Salpietro S, Carenzi L, Moioli M, Cicconi P, Marchetti G, Mussini C, Puzzolante C, Gori A, Lapadula G, Abrescia N, Chirianni A, Guida M, Gargiulo M, Baldelli F, Francisci D, Parruti G, Ursini T, Magnani G, Ursitti M, Cauda R, Andreoni M, Antinori A, Vullo V, Cingolani A, d'Avino A, Ammassari A, Gallo L, Nicastri E, Acinapura R, Capozzi M, Libertone R, Tebano G, Cattelan A, Mura M, Madeddu G, Caramello P, Di Perri G, Orofino G, Bonora S, Sciandra M, Pellizzer G, Manfrin V.

Author information

1
Sapienza University of Rome, Polo Pontino, Latina.
2
San Paolo Hospital.
3
Cenci Bolognetti Foundation.
4
UCL Medical School, London, United Kingdom.
5
Sacco Hospital.
6
Santa Maria Annunziata Hospital, Florence.
7
Bari University.
8
Siena University Hospital.
9
Niguarda Ca' Grande Hospital, Milan.
10
Ospedali Riuniti, Brescia, Italy.
11
Department of Public Health, Sapienza University of Rome.

Abstract

BACKGROUND:

Chronic cytomegalovirus (CMV) infection has been associated with immunosenescence and immunoactivation in the general population. In human immunodeficiency virus type 1 (HIV-1)-infected people, CMV coinfection, in addition to residual HIV replication and microbial translocation, has been proposed as a key factor in sustaining immune activation, even in individuals with a controlled HIV load.

METHODS:

Patients from the ICONA Study with at least 1 CMV immunoglobulin G (IgG) test available without active CMV disease were included in the analysis. AIDS-defining event or AIDS-related death and severe non-AIDS-defining event or non-AIDS-related death were taken as clinical progression end points. Independent predictors of CMV were identified by multivariable logistic regression. Probabilities of reaching the end points were estimated by survival analyses.

RESULTS:

A total of 6111 subjects were included, of whom 5119 (83.3%) were CMV IgG positive at baseline. Patients with CMV IgG positivity at baseline were more likely to develop a severe non-AIDS-defining event/non-AIDS-related death (adjusted hazard ratio [HR], 1.53 [95% confidence interval {CI}, 1.08-2.16]. In particular, CMV seropositivity was an independent risk factor for cardiovascular and cerebrovascular diseases (adjusted HR, 2.27 [95% CI, .97-5.32]).

CONCLUSIONS:

In our study population, CMV/HIV coinfection was associated with the risk of severe non-AIDS-defining events/non-AIDS-related death, especially with cardiovascular and cerebrovascular events, independently of other prognostic factors. This finding supports a potential independent role of CMV coinfection in vascular/degenerative organ disorders in HIV-infected subjects.

KEYWORDS:

CMV infection; HIV infection; cardiovascular/cerebrovascular events; morbidity; mortality; severe non–AIDS-defining events

PMID:
25081936
DOI:
10.1093/infdis/jiu417
[Indexed for MEDLINE]

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