AIDS (London, England) 2017 01 24() doi 10.1097/QAD.0000000000001412
To assess the association between CMV IgG antibody levels, HIV disease progression, and immune activation in sub-Saharan Africa.
A prospective cohort study was conducted among women enrolled in a trial that was designed to determine the effect of acyclovir on HIV disease progression in Rakai, Uganda.
The primary endpoints were progression to a CD4 T-cell count<250 cells/μL, non-traumatic death, or initiation of ART. CD4 T-cell counts, HIV viral load, C-reactive protein, and soluble CD14 levels were assessed biannually for 24 months. CMV IgG antibody were measured at baseline among all women, and annually among a subset of women who initiated ART during the study. RESULTS
There were 300 HIV/CMV coinfected participants who contributed a total of 426.4 person-years with a median follow-up time of 1.81 years. Compared to the lowest CMV IgG tertile group at baseline, the highest CMV IgG tertile group was associated with an increased risk to reach a primary endpoint independent of acyclovir use, age, CD4 T-cell count, and HIV viral load at baseline (adjHR = 1.59;[95%CI = 1.05-2.39];P = 0.027). Among pre-ART visits (n = 1,200), women in the highest baseline CMV IgG tertile had increasing annual rates of sCD14 and CRP levels, which was not observed for the low CMV IgG tertile group. Compared to pre-ART visits, CMV IgG antibody levels were higher post-ART initiation, and concurrent levels remained associated with sCD14 and CRP during suppressive ART (n = 95).
The magnitude of the immune response to CMV was associated with HIV disease progression and immune activation in sub-Saharan Africa.