Cytomegalovirus infections in HIV/AIDS patients: prevalence, disease-associated factors and ganciclovir resistance – Research

Introduction:

Cytomegalovirus (CMV) is an opportunistic pathogen that causes various end-organ diseases. In HIV patients, it is linked to unfavourable progression even in the era of anti-retroviral therapy (ART). Cases of CMV drug resistance may worsen the situation. This study aimed to determine the prevalence of CMV-HIV co-infection, its associated factors and genotypic detection of ganciclovir-resistant CMV.

Materials and methods:

The clinical and laboratory data of 358 HIV patients clinically suspected of CMV infections from December 2018 to December 2020 in Sungai Buloh Hospital, Selangor, Malaysia, were retrospectively analysed. Forty samples were tested for ganciclovir-resistant UL97 mutations (M460I and M460V) using a high-resolution melting curve (HRM) and Sanger sequence analysis.

Results:

The prevalence of CMV infection among HIV patients, detected in plasma, cerebrospinal fluids, vitreous fluids and tissue specimens by CMV PCR, was 60.3% (216/358). Pneumonitis (100/216, 46.3%) and gastrointestinal diseases (65/216, 30.1%) were the predominant clinical presentations of CMV-HIV co-infection, followed by retinitis 5.6% (12/216). The majority of HIV patients (84.6%) who succumbed to death were co-infected with CMV. There were significant associations (p<0.05) between ART status, HIV viral load and CD4 cell count with CMV infection when tested individually. In multivariate analysis, CD4 cell count showed significant association, where decreased CD4 cell count increases the likelihood of CMV infection. No ganciclovir-resistant mutations were detected.

Conclusion:

Despite the high prevalence of CMV infection, the absence of ganciclovir-resistant strain is a good indication. However, the possibility of drug resistance by other gene mutations in different codons cannot be ruled out using this HRM method.