Low rate of CMV end-organ disease in HIV-infected patients despite low CD4+ cell counts and CMV viremia: results of ACTG protocol A5030

HIV Clin Trials. May-Jun 2009;10(3):143-52. doi: 10.1310/hct1003-143.

Abstract

Purpose: To describe cytomegalovirus (CMV) end-organ disease (EOD) rate in AIDS patients with low CD4+ cell count despite HAART who were enrolled in a randomized, placebo-controlled trial of preemptive valganciclovir (VGCV) to prevent CMV EOD in those with CMV viremia.

Methods: Subjects (N = 338) were HIV-infected with CD4+ count <100 cells/mm3, plasma HIV RNA >400 copies/mL, and on stable or no HAART. All underwent plasma CMV DNA PCR testing every 8 weeks (Step 1); those with detectable CMV DNA were randomized to VGCV or placebo (Step 2).

Results: Plasma CMV DNA was detected in 68 (20%), of whom 4 developed CMV EOD. During Step 1, 53 died. Of the 47 who entered Step 2 (24 VGCV, 23 placebo), CMV EOD was diagnosed in 10 (4 VGCV, 6 placebo) and 15 died (7 VGCV, 8 placebo). Of those randomized to placebo, 14% were diagnosed with CMV EOD at 12 months.

Conclusions: We observed a lower CMV EOD rate among subjects receiving HAART than predicted based on published literature. However, mortality was high in this study. Our findings suggest that preemptive anti-CMV therapy in patients with persistently low CD4+ cell counts in the current treatment era may not be warranted given the low incidence of CMV EOD and high all-cause mortality observed in this study population.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy
  • AIDS-Related Opportunistic Infections / mortality*
  • AIDS-Related Opportunistic Infections / virology*
  • Acquired Immunodeficiency Syndrome / drug therapy
  • Acquired Immunodeficiency Syndrome / virology
  • Adult
  • Antiretroviral Therapy, Highly Active
  • Antiviral Agents / administration & dosage
  • CD4 Lymphocyte Count
  • Cytomegalovirus / genetics
  • Cytomegalovirus / isolation & purification
  • Cytomegalovirus Infections / drug therapy
  • Cytomegalovirus Infections / mortality*
  • Cytomegalovirus Infections / virology
  • Double-Blind Method
  • Ganciclovir / administration & dosage
  • Ganciclovir / analogs & derivatives
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / mortality
  • Humans
  • Middle Aged
  • Polymerase Chain Reaction
  • Proportional Hazards Models
  • Valganciclovir
  • Viremia / drug therapy
  • Viremia / epidemiology*

Substances

  • Antiviral Agents
  • Valganciclovir
  • Ganciclovir

Grant support