Cytomegalovirus End Organ Disease in Iranian HIV-1 Infected Patients with CD4+ Cell Counts Less Than 100 Cells/mm3

Cytomegalovirus End-Organ Disease (CMV-EOD) is a seriously debilitating illness in patients with advanced HIV-1 infection, typically occurring with CD4+ cell counts of < 100 cells/mm3.

This study aimed to evaluate the prevalence of CMV-EOD in adult patients with advanced HIV-1 infection (CD4+ count < 100 cells/mm3).

Using a convenience sampling method, a cross-sectional study was conducted on 82 patients with advanced HIV-1 infection in Iran between April 2016 and April 2018. We collected baseline characteristics (age, sex, route of HIV-1 transmission, Hepatitis C Virus (HCV) infection, Hepatitis B Virus (HBV) infection, CMV IgG, and treatment status for HIV-1 infection) and CD4 counts. The entire patients underwent clinical examinations for the diagnosis of CMV-EOD by experienced clinicians. Statistical analysis was used to measure the differences between categorical variables and the outcome of CMV-EOD diagnosis.

Fourteen (17.07%) out of 82 HIV-1-infected patients were diagnosed with opportunistic infection due to CMV. Among 14 patients with CMV-EOD, retinitis occurred in the majority of patients (64.28%), followed by colitis (21.42%) and encephalitis (14.28%). No significant correlation was found between the outcome of CMV-EOD and HBV infection (P = 1.00), HCV infection (P = 0.55), and treatment status for HIV-1 infection (P = 0.53). We detected CMV-EOD more frequently among injecting drug users and patients with positive CMV-IgG (P = 0.12 and P = 0.41, respectively). The ophthalmic examination had clinical usefulness for HIV-1 positive patients with CD4 counts of < 100/mm3.

It is assumed that the CD4+ cell count is not the sole predictor of the risk of developing CMV-EOD. Further large-scale studies are required for a better understanding of risk factors involved in the occurrence of CMV-EOD in HIV-1 positive patients.