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Dunn JP. An overview of current and future treatment options for patients with cytomegalovirus retinitis. Expert Opin Orphan Drugs 2014. [DOI: 10.1517/21678707.2014.945906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Vogel JU, Otte J, Koch F, Gümbel H, Doerr HW, Cinatl J. Role of human cytomegalovirus genotype polymorphisms in AIDS patients with cytomegalovirus retinitis. Med Microbiol Immunol 2012; 202:37-47. [PMID: 22669631 DOI: 10.1007/s00430-012-0244-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 05/08/2012] [Indexed: 12/20/2022]
Abstract
Although several host factors have been identified to influence the course of HCMV infection, it still remains unclear why in AIDS patients without highly active antiretroviral therapy human cytomegalovirus (HCMV) retinitis is one of the most common opportunistic infections, whereas in other immunosuppressed individuals it has a low incidence. It was suggested that HCMV glycoprotein B strains may be suitable as marker for virulence and HCMV retinitis. Moreover, UL144 ORF, a member of the TNF-α receptor superfamily, may play a crucial role in innate defences and adaptive immune response of HCMV infection. Furthermore, sequence analyses of HCMV genes UL128, UL130, and UL131A as major determinants of virus entry and replication in epithelial and other cell types were performed. To evaluate the association of sequence variability of depicted viral genes with HCMV retinitis and in vitro growth properties in retinal pigment epithelial cells (RPE) and human foreskin fibroblasts (HFF), we compared 14 HCMV isolates obtained from vitreous fluid and urine of AIDS patients with clinically proven HCMV retinitis. Isolates were analyzed by PCR cycle sequencing and phylogenetic analysis. In addition, sequences of HCMV strains AF1, U8, U11, VR1814, and its cell culture adapted derivates were included. Sequence analysis of gB yielded three genetic subtypes (gB type 1 (5 isolates), gB type 2 (12 isolates), and gB type 3 (5 Isolates)), whereas sequence analysis of UL144 showed a greater diversity (7 isolates type 1A, 2 isolates type 1C, 7 isolates type 2, and 3 isolates type 3). In contrast, the UL128, UL130, and UL131A genes of all low-passage isolates were highly conserved and showed no preferential clustering. Moreover, in HFF and RPE cells, all of our HCMV isolates replicated efficiently independently of their genetic subtype. In conclusion, beside a possible link between the gB subtype 2 and HCMV retinitis, our study found no direct evidence for a connection between UL144/UL128/UL130/UL131A genotypes and the incidence of HCMV retinitis in AIDS patients.
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Affiliation(s)
- Jens-Uwe Vogel
- Institute of Medical Virology, Goethe University Hospital, Frankfurt am Main, Germany.
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Vogel JU, Fleckenstein C, Wagner M, Gümbel HOC, Theegarten D, Cinatl J, Doerr HW. The human eye (retina): a site of persistent HCMV infection? Graefes Arch Clin Exp Ophthalmol 2005; 243:671-6. [PMID: 15672249 DOI: 10.1007/s00417-004-0965-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2004] [Revised: 05/10/2004] [Accepted: 06/16/2004] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Human cytomegalovirus (HCMV) retinitis frequently occurs in severely naturally and iatrogenically immunocompromised patients. It has been shown that the immune-privileged retina is a major site of HCMV infection in AIDS patients. It is conceivable either that during the immunosuppression HCMV infection reactivates in various other organs viremically affecting the retina or that HCMV persisting in the retina may locally reactivate and result in HCMV retinitis. METHODS As there is still controversy about the sites of HCMV latency and persistence we investigated 75 eyes of HIV-seronegative patients undergoing enucleation due to a variety of malignant and non-viral benign ophthalmic disorders for the retinal presence of HCMV antigen and DNA. RESULTS None of the analyzed patients had symptoms of HCMV retinitis. Immunohistologic staining as well as Taq Man DNA PCR analysis showed all samples to be free of HCMV. CONCLUSIONS Our data suggest that the human eye is rather unlikely to be a site of productive or latent HCMV persistence.
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Affiliation(s)
- Jens-Uwe Vogel
- Institute of Medical Virology, Center of Hygiene, University Hospital, Johann Wolfgang Goethe University, Paul-Ehrlich Strasse 40, 60596 Frankfurt am Main, Germany.
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Hodge WG, Boivin JF, Shapiro SH, Lalonde RG, Shah KC, Murphy BD, Dionne MA, Goela A. Clinical risk factors for cytomegalovirus retinitis in patients with AIDS. Ophthalmology 2004; 111:1326-33. [PMID: 15234132 DOI: 10.1016/j.ophtha.2004.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2003] [Accepted: 03/02/2004] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To determine the clinical risk factors for cytomegalovirus (CMV) retinitis in patients with AIDS. DESIGN A case-control study. PARTICIPANTS The study included 120 patients in whom CMV retinitis had been diagnosed from 1990 through 1999 (cases) and 159 patients without CMV retinitis from the same period (controls). All individuals had AIDS and CD4 counts less than 50 cells/microl at the time of diagnosis of retinitis in the cases or on the corresponding date for the controls. METHODS Clinical risk factors were determined by history or physical examination. Confounders controlled for included CD4 count, hospital center, and a series of variables to control for confounding by drug treatment. Statistical analysis was performed by multivariate logistic regression. A systematic model-building strategy was developed from assumption testing to model building to model checking. MAIN VARIABLES MEASURED: Presence of visual symptoms, retinal microinfarctions (cotton-wool spots), history of opportunistic infections, and risk factors for human immunodeficiency virus acquisition were determined and compared in both groups. RESULTS The following clinical risk factors were significant predictors of CMV retinitis: flashing lights or floaters (odds ratio [OR], 11.42; 95% confidence interval [CI], 3.43 to 38.01), cotton-wool spots (OR, 2.90; 95% CI, 1.01 to 8.29), number of previous opportunistic infections (OR, 1.81; 95% CI, 1.24 to 2.64), previous nonocular CMV infection (OR, 82.99; 95% CI, 6.86 to 1004.58), previous Mycobacterium infection (OR, 3.41; 95% CI, 0.99 to 11.85), and homosexuality (OR, 2.83; 95% CI, 1.13 to 7.12). CONCLUSIONS Based on this study, clinical variables have been identified that elevate the risk of CMV retinitis. These findings may be useful to clinicians and health policy experts in developing rational guidelines for screening, examination frequency, and targeted prophylaxis for CMV retinitis in patients with AIDS.
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Affiliation(s)
- William G Hodge
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
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Reus S, Portilla J, Gimeno A, Sánchez-Payá J, García-Henarejos JA, Martínez-Madrid O, Usó J, Roca B, Galindo MJ, López-Aldeguer J. [Predictors of progression and death in patients with advanced HIV infection in the era of highly active antiretroviral therapy]. Enferm Infecc Microbiol Clin 2004; 22:142-9. [PMID: 14987534 DOI: 10.1016/s0213-005x(04)73054-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To assess the factors associated with progression of infection and death in HIV-positive patients with severe immunodepression in the era of highly active antiretroviral therapy (HAART). METHODS We studied 146 HIV-infected patients with < 100 x 10(6)/L CD4+ lymphocytes and positive cytomegalovirus (CMV) serology enrolled between December 1997 and October 1998 and prospectively followed a median of 12.1 months. The main outcome measures were progression of HIV infection, defined as the appearance of a new AIDS-defining disease (CDC category C) or death. HIV viral load, lymphocyte count (CD4+ and CD8+), HAART administration and other clinical variables were evaluated at baseline. CMV viremia (determined by PCR) and HAART efficacy were recorded during follow-up. RESULTS Progression was observed in 40% of patients and 17% died. Factors associated with progression or death were CD4+ lymphocyte count less than 50 x 10(6)/L, CD8+ lymphocyte count less than 500 x 10(6)/L, HIV viral load more than 300,000 copies RNA/mL, CMV viremia, and absence or inefficacy of HAART. In the multivariate model, absence of HAART and low CD4+ and CD8+ counts remained statistically associated with progression, but the only variable associated with death was CMV viremia. CONCLUSIONS In patients with advanced HIV infection, CD4+ and CD8+ cell count and HAART were the most important factors related to progression, and CMV viremia was the strongest predictor of death.
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Affiliation(s)
- Sergio Reus
- Servicio de Enfermedades Infecciosas. Hospital General Universitario de Alicante. Spain
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Wei LL, Park SS, Skiest DJ. Prevalence of visual symptoms among patients with newly diagnosed cytomegalovirus retinitis. Retina 2002; 22:278-82. [PMID: 12055459 DOI: 10.1097/00006982-200206000-00004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the prevalence and type of visual symptoms among human immunodeficiency virus (HIV)-positive patients with newly diagnosed cytomegalovirus (CMV) retinitis. METHODS The authors conducted a retrospective review of the charts of all HIV type 1-infected patients at Parkland Memorial Hospital (Dallas, TX) who had newly diagnosed CMV retinitis between July 1, 1993, and September 30, 1997. Information recorded included demographics, results of laboratory evaluations including CD4 cell count, visual symptoms at the time of diagnosis, and the zone and extent of retinal involvement at presentation. Visual symptoms in the patients with CMV retinitis were compared with those in a control group of HIV-positive patients who were screened for CMV retinitis but were not diagnosed with retinitis. RESULTS Of 183 eyes (138 patients), 83% (88% of patients) had visual symptoms at the time of diagnosis. The most common presenting symptoms were blurred vision (67% of patients), floaters (49%), flashes of light (16%), eye pain (7%), and scotomata (3%). Compared with the control group of patients without CMV retinitis, patients with CMV retinitis were more likely to have any eye symptoms (88% versus 53%, respectively) as well as blurred vision, floaters, and either blurred vision or floaters (P < 0.0001). Eyes with zone 1 retinal involvement had an 88% incidence of visual symptoms at the time of diagnosis compared with 77% of eyes with peripheral retinal involvement (zones 2 and 3) (P > 0.05). Patients with zone 1 disease were more likely to note blurred or decreased vision than were patients with zone 2 or 3 disease (75% versus 47%, respectively; P < 0.0001). Eyes with <25% retinal involvement had a 76% rate of visual symptoms, which was significantly lower than the 90% rate noted among eyes with >25% retinal involvement (P < 0.05). CONCLUSIONS Most HIV-infected patients with newly diagnosed CMV retinitis had visual symptoms at presentation regardless of the zone of retinal involvement. The incidence of visual symptoms correlated with the degree of retinal involvement.
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Affiliation(s)
- Lisa L Wei
- Department of Ophthalmology, The University of Texas Southwestern Medical Center at Dallas, Texas 75390, USA
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Skiest DJ. Focal neurological disease in patients with acquired immunodeficiency syndrome. Clin Infect Dis 2002; 34:103-15. [PMID: 11731953 DOI: 10.1086/324350] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Focal neurological disease in patients with acquired immunodeficiency syndrome may be caused by various opportunistic pathogens and malignancies, including Toxoplasma gondii, progressive multifocal leukoencephalopathy (PML), cytomegalovirus (CMV), and Epstein-Barr virus-related primary central nervous system (CNS) lymphoma. Diagnosis may be difficult, because the findings of lumbar puncture, computed tomography (CT), and magnetic resonance imaging are relatively nonspecific. Newer techniques have led to improved diagnostic accuracy of these conditions. Polymerase chain reaction (PCR) of cerebrospinal fluid specimens is useful for diagnosis of PML, CNS lymphoma, and CMV encephalitis. Recent studies have indicated the diagnostic utility of new neuroimaging techniques, such as single-photon emission CT and positron emission tomography. The combination of PCR and neuroimaging techniques may obviate the need for brain biopsy in selected cases. However, stereotactic brain biopsy, which is associated with relatively low morbidity rates, remains the reference standard for diagnosis. Highly active antiretroviral therapy has improved the prognosis of several focal CNS processes, most notably toxoplasmosis, PML, and CMV encephalitis.
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Affiliation(s)
- Daniel J Skiest
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9113 , USA.
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Zambarakji HJ, Newson RB, Mitchell SM. CMVR diagnoses and progression of CD4 cell counts and HIV viral load measurements in HIV patients on HAART. Br J Ophthalmol 2001; 85:837-41. [PMID: 11423459 PMCID: PMC1724032 DOI: 10.1136/bjo.85.7.837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To assess the impact of highly active antiretroviral therapy (HAART) on the prevalence and progression of CMV retinitis (CMVR) among AIDS patients with baseline CD4 cell counts <100 cells x 10(6)/l. METHODS A longitudinal cohort study of 1292 patients. CD4 cell counts and HIV viral load measurements were obtained before commencing therapy, at 3 months, 1 year, 2 years, and at last follow up. The CMVR prevalence rate was measured for the subgroup with baseline CD4 cell counts <100 cells x 10(6)/l. CMVR adverse event (AE) rates per 100 person days at risk were calculated for the subgroup with CMVR and baseline CD4 cell counts <100 cells x 10(6)/l. RESULTS 1292 patients were started on HAART. 8% of patients had CD4 counts <50 cells x 10(6)/l and 40% had detectable HIV viral load at last follow up. The prevalence of CMVR for the subgroup with baseline CD4 <100 cells x 10(6)/l was 10%. For those with baseline CD4 <100 cells x 10(6)/l, the mean CMVR AE rate was greatest during the first 6 months of follow up after HAART commencement (p <0.003). The mean AE rate per 100 person days at risk was 0.36 (95% CI 0.167 to 0.551) before starting HAART, and 0.14 (95% CI 0.085 to 0.199) after starting HAART (p = 0.03). CONCLUSIONS HAART significantly prolongs the disease-free intervals in patients with pre-existing disease but recurrences persist within the first 6 months of starting therapy. AE were absent beyond 18 months of follow up in all patients including those with persistently low CD4 counts and detectable HIV viral load indicating clinical immunorestoration. New methods for monitoring the response to therapy are needed to identify those at risk.
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Affiliation(s)
- H J Zambarakji
- Department of Ophthalmology, Chelsea and Westminster Hospital, London, UK
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Binquet C, Saillour F, Bernard N, Rougier MB, Leger F, Bonnal F, Dabis F. Prognostic factors of survival of HIV-infected patients with cytomegalovirus disease: Aquitaine Cohort, 1986-1997. Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GECSA). Eur J Epidemiol 2000; 16:425-32. [PMID: 10997829 PMCID: PMC4710783 DOI: 10.1023/a:1007627508918] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To analyse survival of HIV-infected patients who developed cytomegalovirus (CMV) disease and to identify prognostic factors of their survival. METHODS Cases of CMV disease diagnosed in the Aquitaine Cohort of HIV-infected patients (n = 4297) during the 1986-1996 period, were reviewed using standardised definitions. Follow-up was extended to December 1997. Cox model was used to determine factors associated with survival after the initial manifestations of CMV disease, considering protease inhibitor (PI) prescription and anti-CMV treatment as time dependent covariates. RESULTS 253 patients presented a CMV disease of which 221 (87.3%) died (median survival: 7 months). A better prognosis for survival was associated with: PI prescription [relative hazard (RH): 0.26; 95% confidence interval (CI): 0.11-0.59], anti-CMV treatment (RH: 0.37; CI: 0.25-0.54), CD4+ lymphocyte cell count > 50/mm3 (RH: 0.66; CI: 0.47-0.94) and absence of neoplasia (RH: 0.70; CI: 0.52-0.94) whereas the disseminated CMV disease worsened prognosis (RH: 1.83; CI: 1.20-2.80). CONCLUSION Antiretroviral treatment including PI, improved short-term prognosis of CMV disease regardless of its clinical manifestations.
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Affiliation(s)
- Christine Binquet
- Epidémiologie, Santé Publique et Développement
INSERMUniversité Bordeaux Segalen - Bordeaux 2146 Rue Léo Saignat 33076 Bordeaux Cedex
- * Correspondence should be addressed to Christine Binquet
| | - F. Saillour
- Epidémiologie, Santé Publique et Développement
INSERMUniversité Bordeaux Segalen - Bordeaux 2146 Rue Léo Saignat 33076 Bordeaux Cedex
- CISIH Centre d'Information et de Soins de l'Immunodéficience Humaine
CHU Bordeaux [Bordeaux]
| | - Noëlle Bernard
- Service de Médecine Interne
CHU Bordeaux [Bordeaux]Hôpital Saint-André33076 Bordeaux
| | - M. B. Rougier
- Service d'Ophtalmologie [Bordeaux]
Université Bordeaux Segalen - Bordeaux 2CHU Bordeaux [Bordeaux]12 Rue Dubernat 33404 Talence Cedex
| | - F. Leger
- Laboratoire d'Anatomie Pathologique
CHU Bordeaux [Bordeaux]Groupe Hospitalier Pellegrin
| | - F. Bonnal
- Service de Médecine Interne
CH Côte BasqueBayonne
| | - François Dabis
- Epidémiologie, Santé Publique et Développement
INSERMUniversité Bordeaux Segalen - Bordeaux 2146 Rue Léo Saignat 33076 Bordeaux Cedex
- CISIH Centre d'Information et de Soins de l'Immunodéficience Humaine
CHU Bordeaux [Bordeaux]
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Abstract
The incidence of cytomegalovirus (CMV) retinitis in AIDS has declined significantly due to the use of highly active antiretroviral therapy (HAART). However, patients with HIV, especially those failing HAART, may still suffer with CMV retinitis, which can lead to significant loss of vision and blindness. Ganciclovir has traditionally been considered the recommended treatment for CMV retinitis; however, due to side effects and the possibility of developing viral resistance, other agents may be preferred in certain situations. Foscarnet, which has similar efficacy to ganciclovir but a different side effect profile, is more difficult to administer and is less well-tolerated. Intravenous cidofovir, which may be more effective than either iv. ganciclovir or foscarnet, can also be used as a first line agent; however, it is associated with toxicity (renal and ocular) and thus needs careful use. Local therapy for CMV retinitis has been a significant advance. The intraocular ganciclovir implant has the highest efficacy of the approved agents and is well-tolerated. Fomivirsen, an oligonucleotide injected intravitreally, is a newly approved agent which offers alternative treatment. Intravitreal ganciclovir or foscarnet, although not approved, have been used successfully in some patients especially those with recurrent or refractory disease. The development of new anti-CMV agents has been stalled by the decreased incidence of the disease. Valganciclovir, a prodrug of ganciclovir, offers excellent oral bioavailability and is the closest to approval of all the new anti-CMV drugs. High ganciclovir blood levels are achieved without the complications associated with the requirement for long-term iv. access. The monoclonal antibody (mAb) MSL-109, did not offer a significant advantage when added to traditional anti-CMV therapy. Development plans of other agents such as cyclic HPMPC and lobucavir have been put on hold by their respective manufacturers. Adefovir is a nucleotide analogue that possesses anti-CMV activity, but is currently only being pursued for the treatment of hepatitis B virus. Other compounds possessing significant anti-CMV activity, including BAY 38-4766 and GW1263W94 are still in the early stages of development.
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Affiliation(s)
- V F Hoffman
- Department of Pharmacy, Parkland Health and Hospital System, 5201 Harry Hines, Boulevard, Dallas, TX 75235, USA. . org
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Blank BS, Meenhorst PL, Mulder JW, Weverling GJ, Putter H, Pauw W, van Dijk WC, Smits P, Lie-A-Ling S, Reiss P, Lange JM. Value of different assays for detection of human cytomegalovirus (HCMV) in predicting the development of HCMV disease in human immunodeficiency virus-infected patients. J Clin Microbiol 2000; 38:563-9. [PMID: 10655346 PMCID: PMC86149 DOI: 10.1128/jcm.38.2.563-569.2000] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/1999] [Accepted: 11/01/1999] [Indexed: 11/20/2022] Open
Abstract
In the present prospective study, five blood tests for detection of human cytomegalovirus (HCMV), nucleic acid sequence-based amplification (NASBA) for detection of early (immediate-early antigen) and late (pp67) mRNA, PCR for detection of HCMV DNA (DNA PCR), culture, and pp65 antigenemia assay, and culture and DNA PCR of urine and throat swab specimens were compared for their abilities to predict the development of disease caused by HCMV (HCMV disease). Of 101 human immunodeficiency virus (HIV)-infected patients with =100 CD4(+) lymphocytes per mm(3), 25 patients developed HCMV disease. The pp65 antigenemia assay (sensitivity, 50%; specificity, 89%) and DNA PCR of blood (sensitivity, 69%; specificity, 75%) were most accurate in predicting the development of HCMV disease within the next 12 months. Both blood culture and late pp67 mRNA NASBA had high specificities (91 and 90%, respectively) but low sensitivities (25 and 13%, respectively). The sensitivities of urine culture, DNA PCR, throat swab specimen culture, DNA PCR, and NASBA of blood for detection of the immediate-early antigen were 73, 87, 53, 67, and 63%, respectively, and the specificities were 58, 46, 76, 60, and 72%, respectively. The positive predictive values of all tests however, were low and did not exceed 50%. In conclusion, virological screening by these qualitative assays for detection of HCMV is of limited value for prediction of the development of HCMV disease in HIV-infected patients.
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Affiliation(s)
- B S Blank
- National AIDS Therapy Evaluation Center, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands.
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Singh A, Besson G, Mobasher A, Collman RG. Patterns of chemokine receptor fusion cofactor utilization by human immunodeficiency virus type 1 variants from the lungs and blood. J Virol 1999; 73:6680-90. [PMID: 10400765 PMCID: PMC112752 DOI: 10.1128/jvi.73.8.6680-6690.1999] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) infection is highly compartmentalized, with distinct viral genotypes being found in the lungs, brain, and other organs compared with blood. CCR5 and CXCR4 are the principal HIV-1 coreceptors, and a number of other molecules support entry in vitro but their roles in vivo are uncertain. To address the relationship between tissue compartmentalization and the selective use of entry coreceptors, we generated functional env clones from primary isolates derived from the lungs and blood of three infected individuals and analyzed their use of the principal, secondary, orphan, and virus-encoded coreceptors for fusion. All Env proteins from lung viruses used CCR5 but not CXCR4, while those from blood viruses used CCR5 or CXCR4 or both. The orphan receptor APJ was widely used for fusion by Env proteins from both blood and lung viruses, but none used the cytomegalovirus-encoded receptor US28. Fusion mediated by the secondary coreceptors CCR2b, CCR3, CCR8, and CX3CR1 and orphan receptors GPR1, GPR15, and STRL33 was variable and heterogeneous, with relatively broad utilization by env clones from isolates of one subject but limited use by env clones from the other two subjects. However, there was no clear distinction between blood and lung viruses in secondary or orphan coreceptor fusion patterns. In contrast to fusion, none of the secondary or orphan receptors enabled efficient productive infection. These results confirm, at the level of cofactor utilization, previous observations that HIV-1 populations in the lungs and blood are biologically distinct and demonstrate diversity within lung-derived as well as blood-derived quasispecies. However, the heterogeneity in coreceptor utilization among clones from each isolate and the lack of clear distinction between lung- and blood-derived Env proteins argue against selective coreceptor utilization as a major determinant of compartmentalization.
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MESH Headings
- Antigens, CD/metabolism
- Cell Line, Transformed
- Cloning, Molecular
- Genes, env
- Genetic Variation
- HIV Seropositivity/blood
- HIV Seropositivity/pathology
- HIV Seropositivity/virology
- HIV-1/genetics
- HIV-1/isolation & purification
- HIV-1/metabolism
- HIV-1/pathogenicity
- Humans
- Lung/pathology
- Lung/virology
- Receptors, CCR2
- Receptors, CCR3
- Receptors, CCR5/metabolism
- Receptors, CCR8
- Receptors, CXCR4/metabolism
- Receptors, CXCR6
- Receptors, Cell Surface/metabolism
- Receptors, Chemokine/metabolism
- Receptors, Cytokine/metabolism
- Receptors, G-Protein-Coupled
- Receptors, HIV/metabolism
- Receptors, Interleukin/metabolism
- Receptors, Interleukin-8A
- Receptors, Peptide/metabolism
- Receptors, Virus
- Saccharomyces cerevisiae Proteins
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Affiliation(s)
- A Singh
- Pulmonary and Critical Care Division, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6060, USA
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14
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Affiliation(s)
- D J Skiest
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas 75235-9113, USA.
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