Valganciclovir reduces T cell activation in HIV-infected individuals with incomplete CD4+ T cell recovery on antiretroviral therapy

J Infect Dis. 2011 May 15;203(10):1474-83. doi: 10.1093/infdis/jir060.


Background: Elevated immune activation persists during treated human immunodeficiency virus (HIV) infection and is associated with blunted CD4 recovery and premature mortality, but its causes remain incompletely characterized. We hypothesized that asymptomatic cytomegalovirus (CMV) replication might contribute to immune activation in this setting.

Methods: Thirty antiretroviral therapy-treated HIV-infected CMV-seropositive participants with CD4 counts <350 cells/mm(3) were randomized to receive valganciclovir 900 mg daily or placebo for 8 weeks, followed by an additional 4-week observation period. The primary outcome was the week 8 change in percentage of activated (CD38(+) HLA-DR(+)) CD8(+) T cells.

Results: Fourteen participants were randomized to valganciclovir and 16 to placebo. Most participants (21 [70%] of 30) had plasma HIV RNA levels <75 copies/mL. The median CD4 count was 190 (IQR: 134-232) cells/mm(3), and 12 (40%) of 30 had detectable CMV DNA in saliva, plasma, or semen at baseline. CMV DNA continued to be detectable at weeks 4-12 in 7 (44%) of 16 placebo-treated participants, but in none of the valganciclovir-treated participants (P = .007). Valganciclovir-treated participants had significantly greater reductions in CD8 activation at weeks 8 (P = .03) and 12 (P = .02) than did placebo-treated participants. These trends were significant even among those with undetectable plasma HIV RNA levels.

Conclusions: CMV (and/or other herpesvirus) replication is a significant cause of immune activation in HIV-infected individuals with incomplete antiretroviral therapy-mediated CD4(+) T cell recovery.

Clinical trials registration: NCT00264290.

Publication types

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

MeSH terms

  • Anti-HIV Agents / pharmacology
  • Anti-HIV Agents / therapeutic use*
  • CD4-Positive T-Lymphocytes / drug effects
  • CD4-Positive T-Lymphocytes / physiology*
  • Cytomegalovirus / physiology
  • Cytomegalovirus Infections / complications
  • Cytomegalovirus Infections / immunology
  • DNA, Viral / analysis
  • DNA, Viral / blood
  • Ganciclovir / analogs & derivatives*
  • Ganciclovir / pharmacology
  • Ganciclovir / therapeutic use
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV Infections / immunology
  • Humans
  • Lymphocyte Activation / drug effects*
  • Saliva / virology
  • Semen / virology
  • Valganciclovir
  • Virus Replication


  • Anti-HIV Agents
  • DNA, Viral
  • Valganciclovir
  • Ganciclovir

Associated data