Assessment of the efficacy and safety of pre-emptive anti-cytomegalovirus (CMV) therapy in HIV-infected patients with CMV viraemia
| Autor: | Raphaël Porcher, Catherine Scieux, Sarah Mattioni, Blandine Denis, François Simon, Nathalie De Castro, Jean-Michel Molina, Juliette Pavie |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Opportunistic infection Anti-HIV Agents Congenital cytomegalovirus infection Cytomegalovirus HIV Infections Dermatology Disease Pact Antiviral Agents Polymerase Chain Reaction Immunocompromised Host Acquired immunodeficiency syndrome (AIDS) Internal medicine medicine Humans Valganciclovir Pharmacology (medical) Cumulative incidence Viremia Ganciclovir Retrospective Studies AIDS-Related Opportunistic Infections business.industry Incidence Public Health Environmental and Occupational Health virus diseases Retrospective cohort study Middle Aged Viral Load medicine.disease CD4 Lymphocyte Count Infectious Diseases Treatment Outcome Immunology Cytomegalovirus Infections DNA Viral Female business medicine.drug |
| Zdroj: | International journal of STDAIDS. 26(5) |
| ISSN: | 1758-1052 |
| Popis: | A number of studies have demonstrated that cytomegalovirus (CMV) viraemia is a strong predictor for CMV end-organ disease (EOD) and death in HIV-infected patients. We assess the efficacy and safety of pre-emptive anti-CMV therapy (PACT) for preventing these events. We performed a retrospective study of all HIV-infected patients seen in our institution who had detectable CMV viraemia in 2007. Seventy-one patients with advanced HIV disease (median CD4 cell count = 61 cells/mm3) were studied. Sixteen patients received PACT (mainly valganciclovir). Patients who received PACT had lower CD4 cell counts and higher blood CMV DNA levels. The cumulative incidence of CMV EOD and death at one year was 44% and 21% in patients with and without PACT, respectively ( p = 0.013). Both PACT and high blood CMV DNA levels were significantly associated with CMV EOD and death in unadjusted analysis. In adjusted analyses, only blood CMV DNA levels remained significantly associated with the risk of CMV EOD and death, whereas PACT was associated with a non-significant trend towards reduced CMV EOD or death (hazard ratio: 0.25, p = 0.13). Five patients with PACT experienced severe drug-related adverse events. In conclusion, the use of PACT in HIV-infected patients with CMV viraemia could improve outcome but is associated with significant toxicity. |
| Databáze: | OpenAIRE |
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