Plasma cytomegalovirus DNA, pp65 antigenaemia and a low CD4 cell count remain risk factors for cytomegalovirus disease in patients receiving highly active antiretroviral therapy
| Autor: | Sophie Chaput, Anne-Marie Fillet, Marie-Christine Mazeron, Francois Freymuth, Vincent Jeantils, Dominique Salmon-Ceron, Brigitte Senechal, Norjis Boukli, Nadira Houhou, Christine Katlama, Joël Gozlan, Sophie Matheron, Catherine Leport, Dominique Costagliola |
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| Rok vydání: | 2000 |
| Předmět: |
Adult
Anti-HIV Agents Immunology Congenital cytomegalovirus infection Cytomegalovirus HIV Infections Context (language use) Disease law.invention Cohort Studies Viral Matrix Proteins Pharmacotherapy Risk Factors law Antiretroviral Therapy Highly Active Humans Immunology and Allergy Medicine Blood culture Prospective Studies Polymerase chain reaction Aged AIDS-Related Opportunistic Infections medicine.diagnostic_test business.industry Incidence Hazard ratio virus diseases Middle Aged Viral Load Phosphoproteins Prognosis medicine.disease CD4 Lymphocyte Count Infectious Diseases Cytomegalovirus Infections DNA Viral HIV-1 Reverse Transcriptase Inhibitors business Cohort study |
| Zdroj: | AIDS. 14:1041-1049 |
| ISSN: | 0269-9370 |
| Popis: | To study the natural history and the current risk factors for cytomegalovirus (CMV) disease in the context of highly active antiretroviral therapy (HAART).Prospective multicentre cohort in 15 university hospitals in France.A group of 198 patients with CD4 cell count100 x 10(6) cells/l (or200 x 10(6) cells/l under HAART for at least 2 months), no previous CMV disease and CMV-positive serology were followed every 4 months clinically and for virological testing including HIV RNA and CMV blood markers (culture, pp65 antigenaemia, plasma CMV DNA and CMV late mRNA by the polymerase chain reaction).At inclusion, median CD4 was 77 x 10(6) cells/l (0-308) and 85% of the patients received protease inhibitors. The percentage of patients receiving HAART reached 99% at 12 months. After a follow-up of 23.6 months, the incidence of CMV disease was 3.2/100 patient-years [95% confidence interval (CI) 1.3-5.0]. In univariate Cox models, all the CMV markers, a CD4 cell count remaining75 x 10(6) cells/l and an HIV viral load100,000 copies/ml were predictive for CMV disease. The hazard ratios for CMV disease were 11 for blood culture; 14 and 70 for pp65 antigenaemia ofor = 1 andor = 100 nuclei/200,000 cells, respectively; 35 for plasma CMV DNA; 6 for CMV mRNA; 29 for CD475 x 10(6) cells/l; and 12 for HIV RNA100,000 copies/ml. In a stepwise multivariate analysis, only three covariates were independently associated with the occurrence of a disease: plasma CMV DNA, pp65 antigenaemiaor = 100 nuclei/200,000 cells and a CD4 count75 x 10(6) cells/l.CMV blood markers and CD4 count75 x 10(6) cells/l remain risk factors for CMV disease in patients receiving HAART. Analysis of plasma CMV DNA by the polymerase chain reaction is a reproducible and standardized tool that could be used as a decision marker for initiating CMV pre-emptive therapy. |
| Databáze: | OpenAIRE |
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