Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
CYTOMEGALOVIRUS INFECTION IN THE IMMUNOCOMPROMISED HOST
Serono Symp Publ Raven Press; 59:121-6 1989. Unique Identifier : AIDSLINE ICDB/90660598 Rocchi G; Sarmati L; Ercoli L; Clinic of Infectious Diseases, II Univ. of Rome, 00100 Rome,; Italy
Abstract:
Epidemiologic studies have shown a higher incidence of cytomegalovirus (CMV) infection in patients (pts) with antibody to HIV and individuals at risk from this infection. The high incidence of CMV infection and the increased pathogenicity of CMV in immunocompromised pts, particularly those with HIV infection, has focused attention on the correlation between CMV and the immune system of the host. CMV could act as a cofactor of the HIV infection, accelerating the evolution from the asymptomatic infection to AIDS. This hypothesis is supported to a certain extent by the progressive increase in the specific antibody titer to CMV found in pts infected with HIV in different phases of the infection. The disseminated CMV infection (characterized by fever, hepatosplenomegaly, myalgia, arthralgia, and leukopenia with lymphocytosis) is observed frequently in recipients of bone marrow transplants (BMTs), whereas in pts with AIDS, clinical manifestations caused by localization of the virus in specific organs (eg, lungs, eye, gastrointestinal tract, and adrenal glands) are more frequent. CMV pneumonia is characterized by fever, dyspnea, hypoxemia, and a nonproductive cough. The radiologic picture, which initially can be completely negative, shows unilateral or bilateral interstitial pulmonary infiltration; consolidation of the lungs and solitary nodules are exceptional. Mortality from CMV pneumonia can reach 90%. Retinitis is one of the most frequent disease conditions caused by CMV in pts with AIDS. The enteric localization of CMV is manifested as esophagitis, gastritis, enteritis, and ulcerative colitis. Several other organs in pts with AIDS can be affected by CMV. The diagnosis of CMV infection in immunocompromised pts often can be difficult. Although many antiviral drugs have been used in the treatment of the clinical manifestations of CMV infection, no drug has been entirely effective. Prophylactic treatment with acyclovir (500 mg/m2 every 8 hr) and/or human Ig in high doses has proved effective in reducing the incidence of CMV pneumonia in BMT recipients. Ganciclovir, which is active in vitro against herpes viruses, is useful in the therapy of CMV infection in the immunocompromised pt. However, ganciclovir-resistant strains of CMV may develop in pts who have received a prior course of Ganciclovir. (18 Refs)
Keywords: Antibodies, Viral/BIOSYNTHESIS Cytomegalovirus/*IMMUNOLOGY Cytomegalovirus Infections/DIAGNOSIS/*IMMUNOLOGY Human HIV/*IMMUNOLOGY HIV Infections/*IMMUNOLOGY Immunity, Cellular/PHYSIOLOGY Opportunistic Infections/DIAGNOSIS/*IMMUNOLOGY Risk Factors JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL 900530
M9051003
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Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
