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Ongoing burden of disease and mortality from HIV/CMV coinfection in Africa in the antiretroviral therapy era.

Adland E, Klenerman P, Goulder P, Matthews PC - Front Microbiol (2015)

Bottom Line: Disease manifestations may be a result of direct interplay between the two viruses, or may arise as a secondary consequence of immune dysregulation and systemic inflammation.The problem is most relevant when the rates of coinfection are high, most notably in sub-Saharan Africa, and in children at risk of acquiring both infections early in life.Understanding the interplay between these viruses and developing strategies to diagnose, treat and prevent CMV should be a priority.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatrics, Peter Medawar Building for Pathogen Research, University of Oxford Oxford, UK.

ABSTRACT
Human Cytomegalovirus (CMV) is a well-recognized pathogen in the context of HIV infection, but since the roll out of ART, clinical and scientific interest in the problem of HIV/CMV coinfection has diminished. However, CMV remains a significant cofactor in HIV disease, with an influence on HIV acquisition, disease progression, morbidity, and mortality. Disease manifestations may be a result of direct interplay between the two viruses, or may arise as a secondary consequence of immune dysregulation and systemic inflammation. The problem is most relevant when the rates of coinfection are high, most notably in sub-Saharan Africa, and in children at risk of acquiring both infections early in life. Understanding the interplay between these viruses and developing strategies to diagnose, treat and prevent CMV should be a priority.

No MeSH data available.


Related in: MedlinePlus

Impact of CMV on the immune system. This figure shows the potential for bi-directional interplay between CMV and the immune response. CMV induces a robust humoral and cellular immune response whilst at the same time has a direct influence on normal immune function. Factors such as poor nutrition and low weight, crowded living conditions and other herpes virus coinfections also have an impact on immune function and are associated with increased CMV seroprevalence.
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Figure 3: Impact of CMV on the immune system. This figure shows the potential for bi-directional interplay between CMV and the immune response. CMV induces a robust humoral and cellular immune response whilst at the same time has a direct influence on normal immune function. Factors such as poor nutrition and low weight, crowded living conditions and other herpes virus coinfections also have an impact on immune function and are associated with increased CMV seroprevalence.

Mentions: In the pre-ART era, end-organ disease caused by CMV was the most common presentation of HIV infection, particularly retinitis at absolute CD4+ T cell counts < 50/mm3. These manifestations are now much less frequent as ART successfully preserves CD4 counts, but the more subtle immune dysregulation associated with HIV-CMV coinfection is now recognized as a cause for concern. There is good evidence to support the relationship between CMV infection and increased disease progression and mortality in HIV infection (Table 1). However, it remains unknown whether acquisition or reactivation of CMV infection are markers of the immune dysfunction associated with HIV replication, or whether CMV infection itself is a co-factor that promotes HIV progression. These potential pathways are summarized by Figure 3, highlighting the cross-talk between CMV and the immune system.


Ongoing burden of disease and mortality from HIV/CMV coinfection in Africa in the antiretroviral therapy era.

Adland E, Klenerman P, Goulder P, Matthews PC - Front Microbiol (2015)

Impact of CMV on the immune system. This figure shows the potential for bi-directional interplay between CMV and the immune response. CMV induces a robust humoral and cellular immune response whilst at the same time has a direct influence on normal immune function. Factors such as poor nutrition and low weight, crowded living conditions and other herpes virus coinfections also have an impact on immune function and are associated with increased CMV seroprevalence.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4585099&req=5

Figure 3: Impact of CMV on the immune system. This figure shows the potential for bi-directional interplay between CMV and the immune response. CMV induces a robust humoral and cellular immune response whilst at the same time has a direct influence on normal immune function. Factors such as poor nutrition and low weight, crowded living conditions and other herpes virus coinfections also have an impact on immune function and are associated with increased CMV seroprevalence.
Mentions: In the pre-ART era, end-organ disease caused by CMV was the most common presentation of HIV infection, particularly retinitis at absolute CD4+ T cell counts < 50/mm3. These manifestations are now much less frequent as ART successfully preserves CD4 counts, but the more subtle immune dysregulation associated with HIV-CMV coinfection is now recognized as a cause for concern. There is good evidence to support the relationship between CMV infection and increased disease progression and mortality in HIV infection (Table 1). However, it remains unknown whether acquisition or reactivation of CMV infection are markers of the immune dysfunction associated with HIV replication, or whether CMV infection itself is a co-factor that promotes HIV progression. These potential pathways are summarized by Figure 3, highlighting the cross-talk between CMV and the immune system.

Bottom Line: Disease manifestations may be a result of direct interplay between the two viruses, or may arise as a secondary consequence of immune dysregulation and systemic inflammation.The problem is most relevant when the rates of coinfection are high, most notably in sub-Saharan Africa, and in children at risk of acquiring both infections early in life.Understanding the interplay between these viruses and developing strategies to diagnose, treat and prevent CMV should be a priority.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatrics, Peter Medawar Building for Pathogen Research, University of Oxford Oxford, UK.

ABSTRACT
Human Cytomegalovirus (CMV) is a well-recognized pathogen in the context of HIV infection, but since the roll out of ART, clinical and scientific interest in the problem of HIV/CMV coinfection has diminished. However, CMV remains a significant cofactor in HIV disease, with an influence on HIV acquisition, disease progression, morbidity, and mortality. Disease manifestations may be a result of direct interplay between the two viruses, or may arise as a secondary consequence of immune dysregulation and systemic inflammation. The problem is most relevant when the rates of coinfection are high, most notably in sub-Saharan Africa, and in children at risk of acquiring both infections early in life. Understanding the interplay between these viruses and developing strategies to diagnose, treat and prevent CMV should be a priority.

No MeSH data available.


Related in: MedlinePlus