Cytomegalovirus as a possible cofactor in HIV disease progression

Article Abstract:

On average, there is a 10-year-period between initial infection with the human immunodeficiency virus (HIV) and the development of AIDS. Although some viral replication appears to occur during this period, it is theorized that the virus remains essentially latent until it is activated. A number of cofactors that might trigger activation of latent HIV have been suggested, including other viral infections. Cytomegalovirus infection occurs in a large percentage of most populations, and it has been suggested as a possible cofactor in the development of AIDS. A study of 108 HIV-infected hemophiliacs followed their progress for up to nine years from the time they tested positive for HIV. They were also tested for CMV infection. Results showed that 24 (41 percent) of 58 persons who were positive for CMV, developed AIDS during this period, but only 6 (13 percent) of 46 who tested negative for CMV developed AIDS. Similar studies with herpes simplex infection showed no relation between the status of herpes infection and progression to AIDS. This in no way proves CMV is a cofactor, nor does it provide any evidence as to how it might work as a cofactor. It does suggest that the possibility exists. There are a number of theories on how CMV might act as a cofactor. If both viruses were present in the same cell, viral proteins produced by CMV could activate parts of the HIV virus genome. Some viral infections cause an immunological response that includes production of cytokines. These cytokines may stimulate HIV. CMV infection may help HIV to be taken into cells it would not be able to enter on its own. CMV infections might cause immune responses that bring HIV-infected immune cells into many areas of the body. Future research will attempt to identify viral cofactors that may activate HIV and to develop new treatments that may lead to the prevention of AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Cytomegalovirus infections, Viruses, editorial

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More rapid progression to AIDS in older HIV-infected people: the role of CD4+ T-cell counts

Article Abstract:

Individuals who are over the age of 30 and infected with the human immunodeficiency virus (HIV) progress more rapidly to the disease state of AIDS than younger individuals. The progression to AIDS has been linked to a decrease in the number of CD4+ helper T lymphocytes, a subset of immune cells which are destroyed by HIV. The progression to AIDS was analyzed over a 10-year period in 111 hemophiliacs who were infected with HIV. After being infected with HIV and having antibodies in their blood for seven years, 50 percent of the individuals over 30 years of age had developed AIDS, while only 12 percent of those aged 10 through 19 years old developed full-blown AIDS during the study period. The number of CD4+ cells were analyzed in the two groups. The number of CD4+ cells did not drop more rapidly in older individuals than in younger individuals. Older individuals appear to have a greater risk of progression to AIDS than younger individuals, even if the number of CD4+ cells is similar. The therapeutic implications are that treatment, especially as prophylaxis against opportunistic infections, should begin at higher CD4+ counts in older individuals than in younger individuals. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diseases, Hemophiliacs

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Immunodeficiency and the risk of death in HIV infection

Article Abstract:

Individuals infected with HIV whose blood levels of CD4 lymphocytes (cells of the immune system) remain above 50 per cubic millimeters (mm3) may have a lower risk of death than those whose blood levels are below this number. Immunodeficiency in HIV-positive individuals is caused by a decrease in the number of circulating CD4 lymphocytes. Of 111 hemophiliac patients who became HIV-1 positive between 1979 and 1985, 37 died from HIV-associated causes during the 12-year follow-up period. A mathematical equation estimated that 46% of the patients who were alive 12 years after becoming HIV positive would have a CD4 count above 50 per mm3. An estimated 35% of those who were alive after 12 years would have a CD4 count above 200 per mm3. Patients would have an estimated 15% risk of death if their CD4 count was above 50 per cubic millimeters.

Patient outcomes, Mortality

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