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J Infect Dis. 2015 Sep 15;212(6):899-903. doi: 10.1093/infdis/jiv135. Epub 2015 Mar 5.

Vaginal Cytomegalovirus Shedding Before and After Initiation of Antiretroviral Therapy in Rakai, Uganda.

Author information

1
Department of Infectious Disease, University of California San Diego, La Jolla.
2
Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda Department of Medicine, School of Medicine, Johns Hopkins University.
3
Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health.
4
Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
5
Rakai Health Sciences Program, Entebbe Institute of Public Health, Makerere University, Kampala, Uganda.
6
Clinical Research Directorate/Clinical Monitoring Research Program, SAIC-Frederick, Inc, Frederick National Laboratory for Cancer Research, Maryland.
7
Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda.
8
Rakai Health Sciences Program, Entebbe.
9
Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health Rakai Health Sciences Program, Entebbe.
10
Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda Department of Medicine, School of Medicine, Johns Hopkins University Rakai Health Sciences Program, Entebbe.

Abstract

Vaginal shedding of cytomegalovirus (CMV) DNA was determined longitudinally among 96 women coinfected with human immunodeficiency virus (HIV), herpes simplex virus 2, and CMV starting antiretroviral therapy (ART) during a placebo-controlled trial of HSV-2 suppression with acyclovir in Rakai, Uganda. Vaginal CMV was detected in 75 of 96 women (78.0%) and 379 of 1080 individual visits (35.1%). ART status, higher HIV RNA viral load before ART initiation, and younger age were significantly associated with increased frequency of CMV shedding (P < .01). Compared to pre-ART, CMV shedding peaked from month 2 to month 4 after ART initiation, suggesting possible immune reconstitution inflammatory syndrome. Further studies need to determine the clinical significance of asymptomatic CMV shedding.

KEYWORDS:

Uganda; acyclovir; antiretroviral therapy (ART); cytomegalovirus (CMV); human immunodeficiency virus (HIV); immune reconstitution inflammatory syndrome (IRIS); reactivation

PMID:
25743428
PMCID:
PMC4548459
DOI:
10.1093/infdis/jiv135
[Indexed for MEDLINE]
Free PMC Article

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